論文No4148
Airway Mucus Plugs on Chest Computed Tomography Are Associated with Exacerbations in Chronic Obstructive Pulmonary Disease
Emily Wan, Andrew Yen, Rim Elalami, Scott Grumley, Hrudaya P. Nath, Wei Wang, Sharon Brouha, Padma P. Manapragada, Mostafa Abozeed, Muhammad Usman Aziz, Mohd Zahid, Asmaa N. Ahmed, Nina L. Terry, Pietro Nardelli, James C. Ross, Victor Kim, Sushilkumar Sonavane, Seth J. Kligerman, Jørgen Vestbo, Alvar Agusti, Kangjin Kim, Raúl San José Estépar, Edwin K. Silverman, Michael H. Cho, and Alejandro A. Diaz
AJRCCM, Volume 211, Issue 5, pp. 814–822, 2025.
要約
この研究では、COPD患者における胸部CTで認められる粘液栓の存在が、将来の中等度から重度のCOPD急性増悪のリスク増加と関連していることが、2つの独立した大規模コホート研究（ECLIPSEとCOPDGene）において示されました。
ベースライン時に粘液栓が認められた患者は、粘液栓がない患者と比較して、その後の急性増悪（中等度および重度）のリスクが高く、粘液栓の数が多いほどそのリスクは上昇する傾向にありました。
この関連性は、年齢、性別、肺機能などの他の要因で調整した後も認められました。
Take Home Message
COPD患者において、胸部CT検査で粘液栓が認められることは、将来のCOPD急性増悪のリスクを高める可能性がある。この所見は、急性増悪のリスク評価や、粘液栓をターゲットとした新たな治療戦略の開発に繋がる可能性がある。
Rationale: Acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality. Whether mucus plugs are associated with prospective exacerbations has not been examined extensively.
Objective: To examine associations between mucus plugs on chest computed tomography (CT) and future moderate-to-severe AEs in two independent cohorts with spirometrically-confirmed COPD.
Methods: Mucus plugs were visually identified on baseline chest computed tomography scans from smokers with Global Initiative for Chronic Obstructive Lung Disease grade 2–4 COPD enrolled in two multicenter cohort studies: ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) and COPDGene (Genetic Epidemiology of COPD). Associations between ordinal mucus plug score categories (0, 1–2, and ≥3) and prospectively ascertained AEs, defined as worsening respiratory symptoms requiring systemic steroids and/or antibiotics (moderate to severe) and/or emergency room visit or hospitalization (severe), were assessed using multivariable-adjusted zero-inflated Poisson regression; subjects were exacerbation-free at enrollment.
Measurements and Main Results: Among 3,250 participants in COPDGene (mean age ± SD, 63.7 ± 8.4 yr; FEV1, 50.6 ± 17.8% predicted; 45.1% female) and 1,716 participants in ECLIPSE (age, 63.3 ± 7.1 yr; FEV1, 48.3 ± 15.8% predicted; 36.2% female), 44.4% and 46.0% had mucus plugs, respectively. The incidence rates of AEs were 61.0 (COPDGene) and 125.7 (ECLIPSE) per 100 person-years. Relative to those without mucus plugs, the presence of 1–2 and ≥3 mucus plugs was associated with increased risk (adjusted rate ratio [aRR], 1.07 [95% CI, 1.05–1.09] and 1.15 [1.1–1.2] in COPDGene; aRR, 1.06 [95% CI, 1.02–1.09] and 1.12 [1.04–1.2] in ECLIPSE, respectively) for prospective moderate to severe AEs. The presence of 1–2 and ≥3 mucus plugs was also associated with increased risk for severe AEs during follow-up (aRR, 1.05 [95% CI, 1.01–1.08] and 1.09 [1.02–1.18] in COPDGene; aRR, 1.17 [95% CI, 1.07–1.27] and 1.37 [1.15–1.62] in ECLIPSE, respectively).
Conclusions: Computed tomography–detected mucus plugs are associated with an increased risk for future COPD AEs.