摘要
目的利用高分辨率CT(HRCT)定量指标分析慢性阻塞性肺疾病(COPD)患者的肺气肿及气道重塑改变,并探讨上述指标与肺功能的相关性。方法收集COPD患者(COPD组)109例及正常组33例,COPD组患者根据COPD全球倡议指南,分为GOLDⅠ级组(29例)、GOLDⅡ级组(38例)、GOLDⅢ+Ⅳ级组(42例)。患者均行HRCT和肺功能检查;利用后处理软件自动测量各肺叶HRCT肺气肿定量指标:肺气肿指数(EI)、各肺叶平均肺密度(MLD);气道定量指标:支气管壁面积(WA)、支气管腔面积(LA)、管壁面积占支气管断面总面积的百分比(WA%)。比较上述参数在正常组和COPD不同严重程度亚组之间的差异。应用Spearman法分析上述CT定量指标与肺功能指标的相关性。结果与正常组比较,GOLDⅠ级组双肺上叶EI升高,GOLDⅡ级组各肺叶EI均升高,双肺上叶MLD及左肺下叶MLD降低,GOLDⅢ+Ⅳ级组各肺叶EI均升高,MLD降低(P<0.05)。与正常组比较,GOLDⅠ级组5级支气管WA,4~6级支气管WA%升高,5、6级支气管LA降低;与GOLDⅠ级组比较,GOLDⅡ级组仅6级支气管WA、WA%升高,LA降低;与GOLDⅡ级组比较,GOLDⅢ+Ⅳ级组仅5级支气管WA%降低(P<0.05)。各肺叶EI与第1秒用力呼气容积实测值与预测值百分比(FEV1%)呈负相关,MLD与FEV1%呈正相关(P<0.01),5、6级支气管WA%与FEV1%呈负相关(P<0.05)。结论HRCT肺气肿定量指标、气道定量指标与肺功能具有一定相关性,且随着COPD分级不同而变化,可对COPD评估提供参考价值。
Objective To analyze quantitative indexes of emphysema and airway remodeling in patients with chronic obstructive pulmonary disease(COPD)by using high resolution CT(HRCT),and to explore the correlation between the above indexes and pulmonary function.Methods A total of 109 COPD patients(the COPD group)and 33 normal controls(the control group)were collected.According to the COPD Global Initiative guidelines,COPD patients were divided into the GOLD classⅠgroup(n=29),the GOLD classⅡgroup(n=38)and the GOLD classⅢ+Ⅳgroup(n=42).All patients underwent HRCT examination and pulmonary function examination.The post-processing software was used to automatically measure HRCT quantitative emphysema indexes of each lung lobe,including emphysema index(EI),mean lung density(MLD)of each lobe and airway quantitative indexes[bronchial wall area(WA),bronchial lumen area(LA)and the percentage of the wall area in the total bronchial section area(WA%)].The above parameters were compared between the normal group and the different severity COPD subgroups.Spearman method was used to analyze the correlation between the above CT quantitative indexes and pulmonary function.Results Compared with the normal group,EI in upper lobe of both lungs was increased in the GOLD classⅠgroup,EI in all lobes was increased in the GOLD classⅡgroup,MLD values in upper lobe of both lungs and lower lobe of left lung were decreased,EI in all lobes was increased in the GOLD classⅢ+Ⅳgroup,and MLD was decreased(P<0.05).Compared with the normal group,the WA of grade 5 bronchus and WA%of grade 4-6bronchus were increased in the GOLD classⅠgroup,and LA of grade 5 and 6 bronchus decreased.Compared with the GOLD classⅠgroup,only WA and WA%of grade 6 bronchi were increased in the GOLD classⅡgroup,and LA was decreased.Compared with the GOLD classⅡgroup,WA%of grade 5 bronchial was decreased in the GOLD classⅢ+Ⅳgroup(P<0.05).The measured and predicted percentages of forced expiratory volume in the first second(FEV1%)were negatively correlated with the EI of each lung lobe,and the MLD was positively correlated with FEV1%(P<0.01).The WA%of 5-6 bronchi was negatively correlated with FEV1%(P<0.05).Conclusion HRCT emphy sema quantitative indexes and airway quantitative indexes have certain correlation with pulmonary function.It varies with different COPD grades,which can provide reference value for COPD evaluation.
作者
张凤
方著
袁艺
周芸慧
张国晋
蒲红
刘欢
ZHANG Feng;FANG Zhu;YUAN Yi;ZHOU Yunhui;ZHANG Guojin;PU Hong;LIU Huan(North Sichuan Medical College,Chengdu 610072,China;Department of Radiology,Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science and Technology of China;GE Healthcare,Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science and Technology of China)
出处
《天津医药》
CAS
北大核心
2023年第3期320-325,共6页
Tianjin Medical Journal
基金
四川省干部保健科研基金资助项目(川干研2022-208)。
关键词
肺疾病
慢性阻塞性
肺气肿
体层摄影术
X线计算机
肺功能
肺密度
pulmonary disease
chronic obstructive
pulmonary emphysema
tomography
X-ray computed
pulmonary function
lung density
