{"title":"在COVID-19大流行期间,造血前干细胞移植肺部计算机断层扫描作为肺功能测试的替代方案","authors":"Masaharu Tamaki , Hideki Nakasone , Tadao Aikawa , Yuhei Nakamura , Masakatsu Kawamura , Shunto Kawamura , Junko Takeshita , Nozomu Yoshino , Yukiko Misaki , Kazuki Yoshimura , Shinpei Matsumi , Ayumi Gomyo , Aki Tanihara , Machiko Kusuda , Yu Akahoshi , Shun-ichi Kimura , Shinichi Kako , Noriko Oyama-Manabe , Yoshinobu Kanda","doi":"10.1016/j.bbmt.2020.08.025","DOIUrl":null,"url":null,"abstract":"<div><p>The pulmonary function test (PFT) is an important test for risk stratification before allogeneic transplantation (allo-HCT). However, it might be preferable to avoid PFT as much as possible in the recent era of coronavirus disease 2019 (COVID-19), because PFT requires forced expirations and might produce aerosols, increasing the risk of COVID-19 transmission. Therefore, we tried to predict normal PFT results before allo-HCT based on computed tomography (CT) findings. This study included 390 allo-HCT recipients at our center for whom lung CT images and PFT results before allo-HCT were available. Abnormal CT findings were less likely to be observed in the normal PFT group (47.0% versus 67.4%, <em>P</em> = .015), with a high negative predictive value of 92.9%. In a multivariate analysis, normal CT was significantly associated with normal PFT (odds ratio, 2.47; 95% confidence interval, 1.22 to 4.97; <em>P</em> = .012). A model for predicting normal PFT was constructed based on the results of a multivariate analysis, and the area under the curve of the receiver operating characteristic analysis was 0.656, which gave a sensitivity of 45.5% and a specificity of 86.0%. The relatively high specificity of the model suggested that PFT can be omitted in patients with normal CT findings before allo-HCT.</p></div>","PeriodicalId":9165,"journal":{"name":"Biology of Blood and Marrow Transplantation","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bbmt.2020.08.025","citationCount":"2","resultStr":"{\"title\":\"Pre-Hematopoietic Stem Cell Transplantation Lung Computed Tomography as an Alternative to the Pulmonary Function Test during the COVID-19 Pandemic\",\"authors\":\"Masaharu Tamaki , Hideki Nakasone , Tadao Aikawa , Yuhei Nakamura , Masakatsu Kawamura , Shunto Kawamura , Junko Takeshita , Nozomu Yoshino , Yukiko Misaki , Kazuki Yoshimura , Shinpei Matsumi , Ayumi Gomyo , Aki Tanihara , Machiko Kusuda , Yu Akahoshi , Shun-ichi Kimura , Shinichi Kako , Noriko Oyama-Manabe , Yoshinobu Kanda\",\"doi\":\"10.1016/j.bbmt.2020.08.025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>The pulmonary function test (PFT) is an important test for risk stratification before allogeneic transplantation (allo-HCT). However, it might be preferable to avoid PFT as much as possible in the recent era of coronavirus disease 2019 (COVID-19), because PFT requires forced expirations and might produce aerosols, increasing the risk of COVID-19 transmission. Therefore, we tried to predict normal PFT results before allo-HCT based on computed tomography (CT) findings. This study included 390 allo-HCT recipients at our center for whom lung CT images and PFT results before allo-HCT were available. Abnormal CT findings were less likely to be observed in the normal PFT group (47.0% versus 67.4%, <em>P</em> = .015), with a high negative predictive value of 92.9%. In a multivariate analysis, normal CT was significantly associated with normal PFT (odds ratio, 2.47; 95% confidence interval, 1.22 to 4.97; <em>P</em> = .012). A model for predicting normal PFT was constructed based on the results of a multivariate analysis, and the area under the curve of the receiver operating characteristic analysis was 0.656, which gave a sensitivity of 45.5% and a specificity of 86.0%. The relatively high specificity of the model suggested that PFT can be omitted in patients with normal CT findings before allo-HCT.</p></div>\",\"PeriodicalId\":9165,\"journal\":{\"name\":\"Biology of Blood and Marrow Transplantation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2020-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.bbmt.2020.08.025\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Biology of Blood and Marrow Transplantation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1083879120305401\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Biology of Blood and Marrow Transplantation","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1083879120305401","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 2
摘要
肺功能检查(PFT)是同种异体移植(alloc - hct)前危险分层的重要检查。然而,在最近的2019冠状病毒病(COVID-19)时代,最好尽可能避免PFT,因为PFT需要强制过期,并且可能产生气溶胶,增加了COVID-19传播的风险。因此,我们试图根据计算机断层扫描(CT)的结果来预测同种异体hct前的正常PFT结果。本研究纳入了我们中心的390名接受同种异体hct治疗的患者,他们在接受同种异体hct之前的肺部CT图像和PFT结果都是可用的。PFT正常组CT异常表现较少(47.0% vs 67.4%, P = 0.015),阴性预测值为92.9%。在多变量分析中,正常CT与正常PFT显著相关(优势比,2.47;95%置信区间为1.22 ~ 4.97;p = .012)。基于多变量分析的结果,建立了正常PFT预测模型,受试者工作特征分析曲线下面积为0.656,敏感性为45.5%,特异性为86.0%。该模型的相对高特异性表明,在同种异体CT前CT表现正常的患者可以忽略PFT。
Pre-Hematopoietic Stem Cell Transplantation Lung Computed Tomography as an Alternative to the Pulmonary Function Test during the COVID-19 Pandemic
The pulmonary function test (PFT) is an important test for risk stratification before allogeneic transplantation (allo-HCT). However, it might be preferable to avoid PFT as much as possible in the recent era of coronavirus disease 2019 (COVID-19), because PFT requires forced expirations and might produce aerosols, increasing the risk of COVID-19 transmission. Therefore, we tried to predict normal PFT results before allo-HCT based on computed tomography (CT) findings. This study included 390 allo-HCT recipients at our center for whom lung CT images and PFT results before allo-HCT were available. Abnormal CT findings were less likely to be observed in the normal PFT group (47.0% versus 67.4%, P = .015), with a high negative predictive value of 92.9%. In a multivariate analysis, normal CT was significantly associated with normal PFT (odds ratio, 2.47; 95% confidence interval, 1.22 to 4.97; P = .012). A model for predicting normal PFT was constructed based on the results of a multivariate analysis, and the area under the curve of the receiver operating characteristic analysis was 0.656, which gave a sensitivity of 45.5% and a specificity of 86.0%. The relatively high specificity of the model suggested that PFT can be omitted in patients with normal CT findings before allo-HCT.
期刊介绍:
Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy.
The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.