COPD不同CT表型的CT灌注表现特征及其与肺功能参数的相关性研究  

Lung Perfusion Analysis in Patients with COPD Phenotypes and Correlation with Pulmonary Function Test

作　　者：管宇[1] 夏艺[1] 范丽[1] 张铁峰[1] 刘士远[1] 李兵[1] 于红[1] 

机构地区：[1]上海长征医院影像科,200003

出　　处：《临床放射学杂志》2013年第12期1721-1725,共5页Journal of Clinical Radiology

基　　金：国家自然基金青年基金项目(编号:81000602);国家自然基金面上项目(编号:81370035)

摘　　要：目的评估慢性阻塞性肺疾病(COPD)不同表现型的CT灌注形态特征,半定量分析灌注异常区,进一步评价与肺功能参数间的相关性。方法应用Philips Brilliance 256层iCT,对63例COPD患者行肺实质灌注扫描,并将63例根据HRCT中是否存在肺气肿和支气管壁增厚分为3种表现型:A型:无肺气肿或存在轻微的肺气肿,不考虑是否合并支气管管壁增厚;E型:存在明显的肺气肿,不合并支气管管壁增厚;M型:同时存在明显的肺气肿和支气管管壁增厚。在此基础上按肺叶水平分析3种表现型的CT灌注缺损形态特征(楔形、局限非楔形、广泛斑片形),计算COPD的3种表现型灌注缺损区与正常区的CT值之比R HU(R HU=HU defective/HU normal)。应用SPSS 18.0软件,采用方差分析及Bonferroni检验进行各型R HU间差异研究,Spearman相关系数分析R HU与肺功能检查指标的相关性。结果 63例COPD患者中,A型38例,E型11例,M型14例。A型的灌注缺损主要以局限非楔形为主,E型与M型主要以广泛斑片形为主。A型与E型间R HU差异有统计学意义(P=0.003),A型与M型、M型与E型间R HU差异均无统计学意义(P>0.05)。A型的R HU与用力呼气第1秒量(FEV1)(R=0.48,P=0.002)、用力呼气第1秒量的实测值与预测值的百分比(FEV1%)(R=0.47,P=0.002)、第1秒率(FEV1/FVC)(R=0.42,P=0.008)及用力肺活量(R=0.57,P=0.01)均呈正相关;E型的R HU与FEV1/FVC(R=0.68,P=0.042)呈正相关;M型的R HU分别与FEV1(R=0.72,P=0.019)、FEV1/FVC(R=0.63,P=0.039)、FEV1%(R=0.62,P=0.043)及FVC(R=0.65,P=0.043)呈正相关。结论 COPD 3种表现型灌注缺损形态及半定量分析指标R HU均存在差异,但R HU与FEV1/FVC均有正相关性。Objective To evaluate the morphological characteristics of pulmonary perfusion in different phenotypes of chronic obstructive pulmonary disease （COPD） using 256 slice CT And to analyze the correlation between perfusion defects and pulmonary function test （PFT）. Methods 63 patients with COPD underwent CT perfusion examination. The patients were classified into three phenotypes based on the presence of emphysema and bronchial wall thickening evaluated by high- resolution chest computed tomngraphy （HRCT）. Phenotype A： absence of emphysema, with little emphysema, with or without bronchial wall thickening; Phenotype E ： emphysema without bronchial wall thickening; and phenotype M ; emphy sema with bronchial wall thickening; Then the patterns of perfusion defect （PD） （wedge-shaped, circumscribed non wedge-shaped, and patchy） was observed on pulmonary perfusion imaging at the lobar level for COPD phenotypes. The CT value difference ratio （ Rsu ） between the perfusion defects and the normal lung （ RHu = HU defective / HU normal） was calculated. Analysis of variance and Bonferroni test was applied to the differences among the RHU of COPD phenotypes. The Spearman correlation analysis was used to assess the correlation RHu with pulmonary function test （PFT）. Results There was 38 patients of phenotype A, l 1 patients of phenotype E, and 14 patients of phenotype M in COPD patients. The pattern of PD with phenotype A mainly showed circum scribed non wedge-shape. The pattem of PD with phenotypes E and M main-ly showed patchy shape. There was a significant difference of RHU between phenotype A and phenotype E （P = 0. 003 ）. No significant difference of RHU was found between phenotype A and phenotype M, between phenotype M and phenotype E（P 〉 0.05）. The Spearman correlation test showed that RHu of the phenotype A positively correlated with forced expiratory vol- ume in 1 second （ FEV, ） （ R = 0. 48, P = 0. 002 ）, FEV1% Predicted （ R = 0. 47, P = 0. 002 ）, forced vital capa

关 键 词：慢性阻塞性肺疾病 灌注 表型 

分 类 号：R563.9[医药卫生—呼吸系统]