Kagawa Prefectural University of Health Sciences Research Result Repository

Satoh, Katashi

Murota, Makiko

川県立保健医療大学リポジトリ
Pulmonary Emphysema on CT Screening for Lung
Cancer
言語: English
出版者: 
公開日: 2021-06-21
キーワード (Ja): 
キーワード (En): 
作成者: Satoh, Katashi, Murota, Makiko
メールアドレス: 
所属: 
メタデータ
https://kagawa-puhs.repo.nii.ac.jp/records/305URL
Pulmonary Emphysema on CT Screening for Lung Cancer
Katashi Satoh１）＊, Makiko Murota２）
1)Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural College of Health Sciences
2)Department of Radiology, Faculty of Medicine, Kagawa University
Abstract
Recently, chest CT has been used to screening for lung cancer. To determine the
incidence of pulmonary emphysema（PE）and its severity identified by computed
tomography（CT）screening for lung cancer.
We reviewed ２，７３１ cases（１，８９０ men and ８４１ women, ranging in age from ２１-９１
years）who underwent CT scanning. CT findings were judged abnormal if there were
areas of low attenuation. Among the men, there were １，５９２ smokers including ex-
smokers and ２９８ non-smokers. On the other hand， there were １１４ female
smokers including ex-smokers, and ７２７ non-smokers. CT findings were classified into
normal and four grades（1-4）; grade １, mild, to grade ４, severe.
PE was found in ８２７ of １，５９２（５１．９％）male smokers and in ６ of ２９８（２．０％）
non-smokers. Among women, PE was found in ２７ of １１４（２３．７％）smokers and in １０
of ７２７（１．４％）non-smokers.
PE is related to smoking and progresses with age and cumulative cigarette
smoking dose, from ２９．６％ in age group less than ３０ years to ６５．７％ in age group
of over ７０'s. PE was found in more than half of male smokers on average, if the
severity of PE is ignored.
Key Words: pulmonary emphysema, CT screening, lung cancer, smoking
＊Correspondence to: Katashi Satoh, Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural College of
Health Sciences, ２８１-１Murecho-hara, Takamatsu, Kagawa ７６１-０１２３ Japan
【報告】 香川県立保健医療大学雑誌 第１巻，４３－４７，２０１０
―４３―
Objectives
To determine the incidence of pulmonary
emphysema（PE）and its severity identified by
computed tomography（CT）screening for lung
cancer.
Materials and Methods
We reviewed２，７３１ cases（１，８９０men and８４１
women, ranging in age from ２１-９１ years）who
underwent CT scanning. CT findings were judged
abnormal if there were areas of low attenuation.
Among the men, there were 1，592 smokers
including ex-smokers and ２９８ non-smokers. On
the other hand, there were １１４ female smokers
including ex-smokers, and７２７ non-smokers.
CT findings were classified into normal and
four grades（１-４） ; grade １，mild, to grade
４, severe１）. In all cases, contiguous １-cm
sections encompassed the entire thorax without
using high-resolution reconstruction.
Results
PE were divided to two subtypes: centrilobular
emphysema（Fig．１ a-c）and paraseptal emphysema
（Fig. ２ a-c）. Centrilobular emphysema is by far
the most common form of emphysema and has a
proven association with cigarette smoking .
Paraseptal emphysema can occur as an isolated
phenomenon in young adults. Bullae can develop
in association with any type of PE but are most
common with paraseptal emphysema or
centrilobular emphysenma.
PE was found in ８２７ of １，５９２（５１．９％）male
smokers and in ６ of ２９８（２．０％）non-smokers.
Among male smokers, the prevalence of PE by
grade was : grade １, n＝３８３; grade ２, n＝２０６；
grade３, n＝１５４ and grade４，n＝８４（Fig.３）．
The incidence of PE in men in each age
group : less than ３０ years, n＝８（of ２７,
２９．６％） ; ３０’s, n＝３３（of ９０, ３６．７％）, ４０’s, n＝
１３８（of ２９４，４６．９％） ; ５０’s, n＝２４１（of ５０７,
４７．６％） ; ６０’s,２３１（of ４０６,５６．９％） ; and７０’s,
n＝１７６（of２６８,６５．７％）（Fig．４）．
Figure1-a
Figure1-c
Figure 1 Three cases of centrilobular emphysema:
Figure 1-a, Figure 1-b, Figure 1-c
Arrow(short) : Lesions of emphysema
Arrow(long) : Terminal bronchiole
Figure1-b
―４４―
Figure2-a
Figure2-c
Figure 2 Three cases of paraseptal emphysema;
Figure 2-a, Figure 2-b, Figure 2-c
Figure 2-c The part of bullous wall is continued
to the normal alveoli.
Figure2-b
Figure 4 Incidence of pulmonary emphysema
in male smokers depends on age group.
Severity of PE is same as in Figure 3.
S : smokers N : non-smokers
Figure 3 Incidence of pulmonary emphysema
in male smokers（n＝１，８９０）
The severity of pulmonary emphysema
（PE）on CT is shown from grade（G）1, mild,
to G 4, severe.
Figure 5 Incidence of pulmonary emphysema
in female smokers（n=８４１）. Severity of PE
is same as in Figure 3.
香川県立保健医療大学雑誌 第１巻，４３－４７，２０１０
―４５―
Among women, PE was found in ２７ of １１４
（２３．７％）smokers and in １０ of ７２７（１．４％）non-
smokers. The prevalence of PE by grade was :
grade １, n＝１７; grade ２, n＝６ ; grade ３, n＝４
and grade ４, n＝０（Fig.５）．
There were no statistically significant differences
in cigarette consumption in number of pack-years
according to CT grade.
Materials and Methods
Previous studies concerned with PE detection
included mostly older subjects based on
pulmonary function tests and may not reflect the
true incidence of PE in the general population.
Using CT scanning, PE can be found in young
subjects even in those under age ３０ years.
Although PE can occur in nonsmokers, PE is
strongly related to smoking and progresses with
age and cumulative cigarette smoking dose. PE
was found in more than half of male smokers on
average. Incidentally, one of important clinical
points in PE is complication with lung cancer, in
those cases diagnosis as lung caner is sometimes
difficult（Fig.６,７）．
Reference
１）Satoh K, Kobayashi T, Misao T, Hitani Y,
Yamamoto Y, Nishiyama Y, et al : CT
assessment of subtypes of pulmonary
emphysema in smokers. Chest １２０:７２５―７２９.
２００１．
Figure 6 Adenocarcinoma with pulmonary
emphysema in a 72-year-old male.
Figure 6-a : High-resolution CT. Irregularly
shaped cancer lesion is seen between
cystic lesions of pulmonary emphysema
in anterior segment（S8）of the left lower
lobe.
Figure 6-b. Conventional CT. The nodule
is difficult to diagnose as lung cancer.
Figure 7 Adenocarcinoma with pulmonary
emphysema in 49-year-old man.
The lesion resembles a mushroom due
to pulmonary emphysema on both sides.
―４６―
受付日 ２００９年１０月１６日
受理日 ２００９年１２月２４日
要旨
近年肺癌検診を CTで施行する施設が増加している．その CT画像を利用して肺気腫の発生頻度と重症度を
検討した．
CT検診を受診した２，７３１例（男性１，８９０例，女性８４１例，年齢２１～９１歳）を対象とした．CT所見は肺野の低
吸収域を認めた場合を肺気腫と判定した．
男性では喫煙者が過去喫煙者を含め１，５９２例，非喫煙者は２９８例であった．一方女性では喫煙者が１１４例，非
喫煙者は７２７例であった．CT所見は正常と，軽症の grade１から重症の grade４までの５段階とした．肺気腫
の発症は男性では喫煙者の５１．９％，非喫煙者の２．０％で認められ，一方女性では喫煙者の２３．７％，非喫煙者の
１．４％で認められた．男性の年齢階層別の肺気腫発症では３０歳未満での２９．６％から７０歳以上での６５．７％まで次
第に上昇していた．
肺気腫は喫煙者で若年から発症し，喫煙を持続することで進行することが考えられた．症状のない軽度の肺
気腫を考えると男性喫煙者の半数以上に認められた．
香川県立保健医療大学雑誌 第１巻，４３－４７，２０１０
―４７―


English

Pulmonary Emphysema on CT Screening for Lung Cancer

森口, 靖子

中添, 和代

Japanese

M町における介護予防・生活支援事業の効果 : 主観的満足感(QOL)の測定から

小川, 佳代

障害のある子どもについての見解

関亦, 頼子

松村, 恵子

榮, 玲子

植村, 裕子

有機体学における「メタモルフォーゼ」と人間形成 : ゲーテの「形態学」からの出発

河西, 浩一

戸板, 富久子

宮下, 浩明

高齢糖尿病患者にみられたブホルミンによる低血糖の1例

加太, 英明

獅々堀, 彊

藤本, 千草

高松市およびその周辺の水系におけるビスフェノールAおよびp-n-ノニルフェノール濃度の年間変動

松岡, 千代

石川, 久展

「チームワーク」認識に関する研究 : 自記式質問紙を用いた専門職間比較

斉藤, 静代

内海, 知子

大浦, まり子

松村, 千鶴

成人臨床看護論学内演習の教育効果 : 術後合併症予防の術前指導演習実施後のレポートより

松村, 惠子

子育てにおける文化的背景と性役割 : ネパール王国における乳幼児の子育てに関する経験と認知

Niimi, Michio

Hayashi, Akemi

Nagasawa, Harune

Miyai, Yooichiro

川県立保健医療大学リポジトリ
Epidemiologic Analysis of Metabolic Syndrome
and Chronic Kidney Disease on General Health
Examination in Japanese women
言語: English
出版者: 
公開日: 2021-06-21
キーワード (Ja): 
キーワード (En): 
作成者: Niimi, Michio, Hayashi, Akemi, Nagasawa,
Harune, Miyai, Yooichiro
メールアドレス: 
所属: 
メタデータ
https://kagawa-puhs.repo.nii.ac.jp/records/112URL
Correspondence to: Michio Niimi, Department of Medical Technology, Faculty of Health Sciences, Kagawa Prefectural College of Health
Sciences, 2811 Murecho-hara, Takamatsu, Kagawa 7610123 Japan
Epidemiologic Analysis of Metabolic Syndrome and
Chronic Kidney Disease on General Health Examination
in Japanese women
Abstract
We examined the association between the metabolic syndromeMetSand risk for chronic kidney
diseaseCKDin subjects who had undergone health examinations twice in two years20062007at a rural
internal medicine clinic. We measured the waist circumference of 391 women aged 50 to 96 and determined
MetS and CKD prevalence. MetS was defined according to the Japanese diagnostic criteria. CKD was defined
as dipstick proteinuria1+or estimated glomerular filtration rateeGFRless than 60 ml/min/1.73
calculated by the Modification of Diet in Renal DiseaseMDRDformula for three months or more. The
prevalences of MetS and CKD were 7.9% and 7.4%, respectively. Prevalence of CKD was significantly greater
in subjects with MetS compared with those having no metabolic risk factors29.0% versus 3.2%P<0.001.
Prevalence of CKD was significantly greater in subjects with visceral obesity plus one metabolic abnormality
compared with those having no metabolic risk factors13.4% versus 3.2% P<0.001. The mean serum
creatinine level was higher among persons with MetS compared with those without visceral obesityP<0.001.
The mean eGRF showed a decreasing trend in subjects with MetS. Prevalence of proteinuria in subjects with
MetS was significantly higher that in subjects without MetSP=0.009. The present study indicated that MetS
might be an important factor in the etiology of CKD in Japanese women.
Key Words: metabolic syndrome, chronic kidney disease, medical health checkup
	
Michio Niimi1, Akemi Hayashi1, Harune Nagasawa1and Yooichiro Miyai

1Department of Medical Technology, Faculty of Health Sciences,
Kagawa Prefectural College of Health Sciences
2Miyai Internal Clinic
  - 


INTRODUCTION
The prevalence of metabolic disorders such as
diabetes and dyslipidemia is increasing in the
Japanese elderly population, along with the
westernization of lifestyle. Since the proposal of
syndromeX 1,metabolicsyndromeMetShasbeen
highlighted as a clustering of risk factors for
cardiovasculardiseaseCVD24.
The prevalence of chronic kidney disease
CKDis also rising; about 20% of the Japanese
adult population are predicted to have stage 3 to 5
CKD, which is defined as kidney damage or a
glomerular filtration rateGFRof lessthan60ml
/min per 1.73 for at least three months regardless
of cause 5. CKD is a major risk factor for end-stage
renal disease and cardiovascular disease 67). Cross-
sectional studies have demonstrated a link between
theMetSandCKD 89.
WeexaminedtheprevalenceofMetSandCKDin
women who had undergone a routine medical health
checkup at our Internal Medicine clinic. We also
investigated the association between the MetS and
riskforCKDandproteinuria
SUBJECTS ANDMETHODS
SubjectsandCharacteristics
We examined the prevalence of MetS in subjects
who had undergone health examinations twice
between June 2006 andOctober 2007 at our Internal
Medicine Clinic. We measured the waist
circumference of 391 women aged 50 to 96. The age
distribution of all subjects is shown in Table 1. If an
individualwas receiving drug therapy for highBPor
diabetes mellitus, each item was recorded as a
positive finding regardless of the test data. Subjects
with a clinical history of stroke, or myocardial
infarction were excluded. Informed consent by word
ofmouthwasobtainedfromparticipants
Measurements
Anthropometric data were obtained from the
subjects as height, weight, body mass indexBMI,
and waist circumference. The waist circumference
was measured horizontally at the level of the
umbilicus.Venousbloodwasdrawn in fasting or non-
fasting states, using vacutainer tubes for biomedical
evaluation. Systolic blood pressureSBPand
diastolicbloodpressureDBPweretakenbasically
from the upper right armwith the subject sitting in a
chair.
A urine test result of1+or greater was
considered positive for proteinuria and results of
orwereconsiderednegativeforproteiuria.
Estimated GFR was calculated using the following
equation 10:
eGFR=0.741175age0.203sCrmg/dl1.154
0.742
CKD was defined as a eGFR of less than 60 ml/
min/1.73ordipstickproteinuria1+forthree
monthsormoreregardlessofcause 6,11.
DiagnosticcriteriaofMetS
Thediagnosticcriteria forMetSusedwere those
of the Japanese Society of Internal Medicine 1213.
MetSwasdefinedasawaist circumferenceof at least
90 cm forwomen,whichwas considered the essential
marker of visceral fat accumulation, as well as at
least two of the following three items: 1HDL
cholesterolof less than40mg/dl; 2highBPSBP
of 130 mmHg or more or DBP of 85 mmHg or more;
and 3HbA1c level5.5%oraboveinsteadof fasting
glucose level 1314. We left out the serum
triglyceridesTGand fasting glucose levels from
thediagnosticcriteriabecause it isknown that serum
TGandglucose levelschangebeforeandaftermeals.
DataAnalysis
The results are expressed as the mean value 
standard deviation. Differences in the means were
evaluated by analysis of varianceANOVA.
Relationships between MetS and CKD or
proteinuriawere tested using a χ 2-test. Differences
Table 1 Age distribution of all subjects

withp<0.05wereconsideredsignificant.
RESULTS
Themean age of the subjectswas 69.2  8.9 years
for women. Using the Japanese diagnostic criteria
for MetS, we determined the prevalence of MetS
Table 2. The overall prevalence of MetS was
7.9% in women. The prevalence of visceral obesity
plus one metabolic abnormality was about twice the
prevalenceofMetS.
Table 2 shows the difference of BMI, waist
circumference, BP, HbA1cand HDL-C levels with
visceral obesity, visceral obesity plus one metabolic
abnormality, andMetSorwithout visceral obesity in
this population. Systolic and diastolic BP were
higher in the MetS and visceral obesity plus one
metabolic abnormality groups. The level of HDL-C
was significantly lower in theMetS than in the group
without visceral obesityP<0.01. The level of
HbA1c was significantly higher in the MetS than in
thegroupwithoutvisceralobesityP<0.001.
The mean serum creatinine level was
significantly higher among persons with MetS
compared with those without visceral obesityP<
0.001. The mean eGRF showed a decreasing trend
in subjects with MetS. The mean uric acid level
showedan increasingtrendinsubjectswithMetSand
visceral obesity plus one metabolic abnormality.
Prevalence of proteinuria in subjectswithMetSwas
significantly higher that in subjects without visceral
obesityP=0.009Table3.
The prevalence of CKD was 7.4% in this
studyFig.1.PrevalenceofCKDwassignificantly
greater in subjects with MetS compared with those
no metabolic risk factors29.0% versus 3.2%P<
0.001. Prevalence of CKD was significantly
greater in subjects with visceral obesity plus one
Table 2 Patients profiles in each group
Table 3 Prevalence of proteinuria in each group
	
  - 

metabolic abnormality compared with those having
no metabolic risk factors13.4% versus 3.2%P<
0.001, but there was no differences from the
prevalence of CKD in subjects with visceral obesity
only.
DISCUSSION
We previously reported the prevalence of MetS
inmen andwomen was 21.2% and 9.9%, respectively,
in A city, Japan in 200614. In this study the
prevalence of MetS in women was 7.9%. We found
that about twice as many people with MetS had
visceral obesity and one risk factor in women,
indicating a potential for the prevalence of MetS to
increase in the future. Another study reported a
similarprevalenceofMetSinJapanesewomen 15.
Several previous studies reported on the
prevalence of CKD in the general population in
Japan. Tanaka 9 et al. reported that the prevalence
of CKD in individuals included in a hospital-based
registry was 13.7%. The prevalence of CKD in the
Japanese general population was predicted to be
18.7%about 19 millionbased on a nationwide
epidemiological study in527,594 individuals aged20
years and older211,034 males and 316,560
femaleswho participated in an annual health
examinationprogramconductedin200020045.The
prevalence of CKD is higher in the Japanese adult
population than in the United States
populationabout 11%16. The prevalence of CKD
seems to have been smaller in this study than in the
previous reports. Although the reason for the
discrepancy between our results and a nationwide
epidemiological study has not been determined, it
may be due to the difference of the equation used to
evaluaterenal function 510.
MetS is associated with an increase of CKD in
cross-sectional and longitudinal studies in Japan.
We examined 391 screened subjects in a cross
sectional study in women, and determined that the
MetS group and visceral obesity plus one metabolic
abnormality group were significantly associated
with CKD. Ninomiya et al.17followed up 1,440
community-dwelling individuals in the Hisayama
Study,Japan,withoutCKDfor5yearsandfoundthat
MetS remained an independent risk factor for the
occurrence of CKD. This longitudinal study also
suggest that MetS is a risk factor for developing
CKDintheJapanese.
Additionally, our findings showed that MetS in
women using criteria in Japan were associated with
proteinuria.Miyatakeetal.18reportedtheassociation
of proteinuria with MetS. These studies raise an
Fig 1 Prevalence of chronic kidney diseaseCKDaccording to the non-MetS,
metabolic syndromeMetS, visceral obesityVOplus one risk factorRF,
and visceral obesity. *P<0.001 by χ 2-test.

important issue about the association of MetS with
proteinuria.
There are several mechanisms underlying the
effects of MetS on renal function and proteinuria. A
clinical study suggested that obesity is associated
with renal hyperfiltration and hyperfusion 19.
Previous epidemiological surveys showed that
individual components of MetS including glucose
intolerance, hypertension, and dyslipidemia could
act directly as risk factors for renal damage through
renalorsystemicatherosclerosis 2021.
In conclusion, this study showed that MetS was
associated with CKD in women. Early detection and
treatment of those with MetS are essential to
preventCKD.
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Epidemiologic Analysis of Metabolic Syndrome and Chronic Kidney Disease on General Health Examination in Japanese women

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