Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Importance of Carbon Monoxide Transfer Coefficient (KCO) Interpretation in Patients with Airflow Limitation

기류제한 환자의 일산화탄소확산능 해석에서 폐용적 보정의 의의

  • Seo, Yong Woo (Department of Medicine, Keimyung University School of Medicine) ;
  • Choi, Won-Il (Department of Medicine, Keimyung University School of Medicine) ;
  • Lee, Jeong Eun (Department of Medicine, Keimyung University School of Medicine) ;
  • Park, Hun Pyo (Department of Medicine, Keimyung University School of Medicine) ;
  • Ko, Sung Min (Department of Radiology, Keimyung University School of Medicine) ;
  • Won, Kyoung Sook (Department of Nuclear Medicine, Keimyung University School of Medicine) ;
  • Keum, Dong Yoon (Department of Thoracic Surgery, Keimyung University School of Medicine) ;
  • Lee, Mi-Young (Department of Preventive Medicine, Keimyung University School of Medicine) ;
  • Jeon, Young June (Department of Medicine, Keimyung University School of Medicine)
  • 서용우 (계명대학교 의과대학 내과학교실) ;
  • 최원일 (계명대학교 의과대학 내과학교실) ;
  • 이정은 (계명대학교 의과대학 내과학교실) ;
  • 박훈표 (계명대학교 의과대학 내과학교실) ;
  • 고성민 (계명대학교 의과대학 방사선과) ;
  • 원경숙 (계명대학교 의과대학 핵의학과) ;
  • 금동윤 (계명대학교 의과대학 흉부외과) ;
  • 이미영 (계명대학교 의과대학 예방의학교실) ;
  • 전영준 (계명대학교 의과대학 내과학교실)
  • Received : 2005.04.27
  • Accepted : 2005.09.05
  • Published : 2005.10.30
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Abstract

Background : The single-breath carbon monoxide diffusion capacity (DLCO) and the per unit alveolar volume (KCO; $D_LCO/VA$) gave discordant values when there was an abnormal alveolar volume (VA). However, the clinical significance of the discordant values in patients with airflow limitation has not been examined. This study investigated the $D_LCO$ and KCO changes after improving the airflow limitation. Methods : The baseline $D_LCO$ and KCO with lung volume were measured in patients with an airflow obstruction. The effective alveolar volume was measured using the single-breath $CH_4$ dilution method. The patients divided into two groups according to the baseline values: (1) increased KCO in comparison with the $D_LCO$ (high discordance) (2) decreased or not increased KCO in comparison with the $D_LCO$ (low discordance). The diffusion capacity and lung volume were measured after treatment. Results : There was no significant difference in the baseline lung volumes including the $FEV_1$ and FVC between the two groups. The $FEV_1$ and FVC were significantly increased in the high discordance group compared with the low discordance group after treating the airflow limitation. The $D_LCO$ and alveolar volume were significant higher in the high discordance group compared with the low discordance group while the TLC was not. Conclusion : The discordance between the $D_LCO$ and KCO could be translated into an airflow reversibility in patients with an airflow limitation.

배 경 : 폐확산능 ($D_LCO$)과 폐용적을 보정한 확산계수($D_LCO/VA$; KCO)는 폐포용적이 비 정상적인 경우 차이가 생긴다. 그러나, 기류제한으로 비 정상적인 폐포용적을 가지는 환자에서 이러한 차이의 의미는 연구되지 않았다. 본 연구는 기류제한이 있는 환자에서 기류제한의 호전에 따른 폐확산능과 확산계수의 변화를 연구하고자 한다. 방 법 : 기류제한이 있는 환자에서 기저 폐기능과 더불어 폐확산능을 측정하고, 일회호흡 $CH_4$ 희석법으로 폐포용적을 측정하였다. 기저치에 따라서 환자는 다음의 두 군으로 나누었다. 확산계수(예측치에 대한 백분율)와 확산능(예측치에 대한 백분율)의 비가 115%를 넘는 경우를 고차이군으로 하였고, 115% 미만인 경우를 저차이군으로 하였다. 기류제한을 치료 한 후 폐기능검사와 폐확산능을 반복해서 측정하였다. 결 과 : 고차이군과 저차이군의 기저 폐기능은 유의한 차이가 관찰되지 않았다. 두 군 모두 확산계수의 예측치에 대한 백분율은 평균 113%와 100%로 정상범위였다. 치료 후 추적 폐기능에서 $FEV_1$과 FVC는 저차이군에 비해 고차이군에서 증가하였다. 고차이군에서 치료 후 측정한 폐기능은 기저치에 비해 폐확산능과 폐포용적은 증가하였으나 저차이군에서는 유의한 차이는 관찰되지 않았다. 전폐용적과 잔기량은 치료 전후에 양군 모두에서 유의한 차이가 관찰되지 않았다. 결 론 : 기류제한이 있는 환자에서 확산계수는 정상 범위에 있지만 확산능이 감소한 경우 확산능이 감소하지 않은 환자에 비해 가역적인 기류폐색이 클 것으로 예측할 수 있다.

Keywords

References

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