Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Correlation of Dyspnea and Radiologic Quantity in Patients with COPD

만성폐쇄성폐질환 환자에서 호흡곤란과 영상학적 정량과의 상관관계

  • Jung, Eun Jung (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Kim, Yang Ki (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Lee, Young Mok (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Kim, Ki-Up (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Uh, Soo-Taek (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Kim, Yong Hoon (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Kim, Do Jin (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Park, Choon Sik (Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine) ;
  • Hwang, Jung Hwa (Department of Radiology, Soonchunhyang University College of Medicine)
  • 정은정 (순천향대학교 의과대학 서울병원 내과학교실) ;
  • 김양기 (순천향대학교 의과대학 서울병원 내과학교실) ;
  • 이영목 (순천향대학교 의과대학 서울병원 내과학교실) ;
  • 김기업 (순천향대학교 의과대학 서울병원 내과학교실) ;
  • 어수택 (순천향대학교 의과대학 서울병원 내과학교실) ;
  • 김용훈 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 김도진 (순천향대학교 의과대학 부천병원 내과학교실) ;
  • 박춘식 (순천향대학교 의과대학 부천병원 내과학교실) ;
  • 황정화 (순천향대학교 의과대학 영상의학교실)
  • Received : 2009.03.04
  • Accepted : 2009.04.14
  • Published : 2009.04.30
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Abstract

Background: A lung hyperinflation, or air trapping, caused by expiratory flow-limitation contributes to dyspnea in patients with chronic obstructive pulmonary disease (COPD). Forced expiratory volume in 1 second ($FEV_1$) has served as an important diagnostic measurement of COPD, but does not correlate with patient-centered outcomes such as dyspnea. Therefore, this study was performed to investigate the role of radiologic quantity in evaluating the dyspnea in patients with COPD by measuring lung hyperinflation in chest x-ray and high resolution chest tomography (HRCT). Methods: Fifty patients with COPD were enrolled in this study. Their subjective dyspnea score (modified Borg scale dyspnea index), spirometry, and lung volume were measured. Simultaneous hyperinflations of chest x-ray score ("chest score") and degree of emphysema of HRCT ("HRCT score") were measured. The "chest score" were composed of lung length, retrosternal space width, and height of the arc of the diaphragm and "HRCT score" were composed of severity and extent of emphysema. Results: The mean age of patients was 69 years old and their mean $FEV_1$ was 51.7%. The Borg score significantly correlated with parameters of spirometry and lung volume, including FVC, $FEV_1$, $FEV_1$/FVC, RV, RV/TLC, and DLCO. The Borg score correlated well with "HRCT score", but did not correlate with "chest score". Also, the Borg scale correlates inversely with body mass index. Conclusion: The quantity of emphysema on chest HRCT may serve as an objective marker of dyspnea in patients with COPD.

연구배경: COPD에서 보이는 호흡곤란의 주된 원인이 폐의 과팽창이고 이 과팽창을 치료하는 것이 호흡곤란의 향상에 중요한 것으로 밝혀지고 있다. 그러나 $FEV_1$, FVC만으로는 호흡곤란의 정도와 과팽창을 정확히 측정할 수 없다. 따라서 단순 흉부 방사선에서 관찰되는 폐의 과팽창의 정도와 고해상도흉부 단층촬영에서 폐기종의 정도가 호흡곤란을 객관적으로 알 수 있는 지표가 되는 지를 알아보고자 하였다. 방 법: COPD로 진단 받은 50명(평균 연령 69세, 남자 47명, 여자 3명)을 대상으로 하였다. 폐의 종축, 흉골 뒤공간, 횡격막의 높이를 각각 측정하여 총 0에서부터 3까지로 폐의 과팽창 정도(chest score)를 측정하였고, 고해상도 흉부단층 촬영에서 폐기종의 정도(HRCT score)를 구하여 이를 환자의 호흡곤란의 정도 및 폐용적 검사를 비롯한 폐기능 검사와의 상관관계를 구하였다. 결 과: 호흡곤란의 지수(Borg scale)는 폐기능 검사의 지표인 FVC, $FEV_1$, $FEV_1$/FVC, RV, RV/TLC, DLCO와 유의한 상관관계가 관찰되었다. Borg scale은 HRCT score와 상관관계가 있었으나, chest score와는 상관관계가 없었다. 그리고 Borg scale은 체질량 지수와 역 상관관계가 있었다. 결 론: 고해상도 흉부 단층촬영의 폐기종의 정도는 COPD 환자에서 호흡곤란의 정도를 알 수 있는 객관적 지표가 될 수 있다.

Keywords

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