Toraks bilgisayarlı tomografi ile ölçülen trakea ve toraks çaplarının KOAH ile ilişkisinin değerlendirilmesi

Öz

Amaç: Bu çalışmada, Kronik Obstrüktif Akciğer Hastalığı (KOAH) olan hastalarda toraks bilgisayarlı tomografi (BT) ile ölçülen toraks ve trakea çaplarının solunum fonksiyon testleri (SFT) ile ilişkisinin incelenmesi ve bu ölçümlerin hastalığın yapısal etkilerinin değerlendirilmesindeki yerinin belirlenmesi amaçlandı. Gereç ve Yöntemler: Kesitsel tasarımla gerçekleştirilen çalışmada, 2018–2020 yılları arasında solunum fonksiyon testi ve bodipletismografi uygulanan, toraks BT görüntüleri bulunan 169 hasta retrospektif olarak incelendi. Örneklem büyüklüğü G*Power 3.1 ile a priori güç analizi kullanılarak, α=0,05 ve güç (1–β)=0,80 için minimum 104 olarak hesaplandı. Akciğer malignitesi, interstisyel akciğer hastalığı, plevral hastalık ve göğüs duvarı anomalisi olan hastalar çalışma dışı bırakıldı. Veriler SPSS 25.0 yazılımı ile analiz edildi. Bulgular: KOAH grubunda yaş ortalaması (65±10,8 vs 53±12,5 yıl) ve sigara öyküsü (30 vs 14 paket-yıl) kontrol grubundan anlamlı olarak yüksekti (p<0,001). KOAH grubunda toraks anterior-posterior (AP) çapı (18,39±1,72 vs 17,23±1,74 cm, p<0,001), toraks transvers (TT) çapı (24,6±1,69 vs 23,9±1,79 cm, p=0,008) ve trakea AP çapı (2,23±0,34 vs 2,09±0,32 cm, p=0,006) kontrol grubundan anlamlı olarak yüksek saptandı. Trakea transvers çapında gruplar arasında anlamlı fark gözlenmedi (p=0,077). KOAH grubunda toraks AP çapı ile rezidüel hacim (RV) arasında pozitif (r=0,398, p<0,001), FEV1/FVC oranı ile negatif (r=−0,316, p=0,005) korelasyon saptandı. Lojistik regresyon analizinde, toraks AP çapındaki her 1 cm'lik artış KOAH bulunma olasılığını yaklaşık 1,37 kat artırmaktaydı (OR=1,37; %95 GA: 1,11–1,69; p=0,004). Çok değişkenli lineer regresyon analizinde; yaş (B=0,103; p<0,001), VKİ (B=0,118; p=0,007) ve KOAH varlığı (B=1,121; p=0,002) toraks AP çapının bağımsız belirleyicileri olarak saptandı. Sonuç: Toraks ve trakea AP çaplarındaki artış, KOAH’ta akciğer hiperinflasyonunun somut radyolojik yansımasıdır. Bu ölçümler, özellikle SFT'nin sınırlı olduğu durumlarda, hastalığın fenotiplendirilmesi ve yapısal değişikliklerin takibinde tamamlayıcı parametre olarak kullanılabilir.

Anahtar Kelimeler

• KOAH
• toraks bilgisayarlı tomografi
• solunum fonksiyon testleri
• bodipletismografi
• akciğer hacmi

Destekleyen Kurum

Yok

Etik Beyan

Zonguldak Bülent Ecevit Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır.

Teşekkür

Yok

Evaluation of the relationship between tracheal and thoracic diameters measured by thoracic computed tomography and COPD

Öz

Aim: This study aimed to evaluate the relationship between thoracic and tracheal diameters measured by thorax computed tomography (CT) and pulmonary function tests (PFT) in patients with Chronic Obstructive Pulmonary Disease (COPD), and to determine the role of these measurements in the assessment of the structural effects of the disease. Material and Methods: This cross-sectional study retrospectively examined 169 patients who underwent spirometry and body plethysmography and had thorax CT images between 2018 and 2020. A priori sample size was calculated using G*Power 3.1, yielding a minimum requirement of 104 subjects (α=0.05, power=0.80). Patients with lung malignancy, interstitial lung disease, pleural disease or chest wall anomalies were excluded. Data were analyzed using SPSS 25.0. Results: Mean age (65±10.8 vs 53±12.5 years) and smoking history (30 vs 14 pack-years) were significantly higher in the COPD group (p<0.001). Thoracic AP diameter (18.39±1.72 vs 17.23±1.74 cm, p<0.001), thoracic transverse diameter (24.6±1.69 vs 23.9±1.79 cm, p=0.008), and tracheal AP diameter (2.23±0.34 vs 2.09±0.32 cm, p=0.006) were significantly higher in the COPD group. No significant difference was observed in the tracheal transverse diameter (p=0.077). In the COPD group, a positive correlation was found between thoracic AP diameter and residual volume (r=0.398, p<0.001), and a negative correlation with FEV1/FVC ratio (r=−0.316, p=0.005). In logistic regression, each 1-cm increase in thoracic AP diameter was associated with 1.37-fold greater odds of COPD (OR=1.37; 95% CI: 1.11–1.69; p=0.004). In multivariate linear regression, age (B=0.103; p<0.001), BMI (B=0.118; p=0.007), and COPD presence (B=1.121; p=0.002) were independent determinants of thoracic AP diameter. Conclusion: The increase in thoracic and tracheal AP diameters is a concrete radiological reflection of lung hyperinflation in COPD. These measurements may serve as complementary parameters for phenotyping and structural follow-up, particularly when PFT is limited.

Anahtar Kelimeler

• COPD
• thorax computed tomography
• spirometry
• body plethysmography
• lung volume

Kaynakça

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