慢性阻塞性肺疾病患者小气道重塑及肺叶水平肺气肿的CT定量分析及其与肺功能的相关性研究  

CT quantitative analysis of small airway remodeling and lobe-based emphysema of chronic obstructive pulmonary disease patients and its correlation with pulmonary function test

作　　者：管宇[1] 范丽[1] 夏艺[1] 刘士远[1] 姜彦 

机构地区：[1]第二军医大学附属长征医院影像科,上海200003 [2]飞利浦中国CT研究院,上海200233

出　　处：《中国医学影像技术》2015年第2期181-185,共5页Chinese Journal of Medical Imaging Technology

基　　金：国家自然基金青年基金(81000602);国家自然基金面上项目(81370035);国家自然基金重点项目(81230030);上海市生物医药处重大专项(13411950100)

摘　　要：目的 MSCT定量分析慢性阻塞性肺疾病（COPD）患者小气道重塑及肺叶水平气肿指数（EI）,并探讨小气道定量参数分别与肺功能、气肿指数的相关性。方法60例COPD患者接受肺功能检查后行吸气相MSCT扫描,应用COPD自动分析软件获得右肺上叶尖段（RB1）、右肺中叶外侧段（RB4）、右肺下叶后基底段（RB10）、左肺上叶尖后段（LB1）、左肺下叶后基底段（LB10）第4~6级平均支气管腔内径（LDmean）、平均管壁厚度（WTmean）及管壁面积占支气管断面总面积的百分比的平均值（WA%mean）并计算同级支气管各参数平均值,同时获得5个肺叶肺气肿指数（EI,EI=每个肺叶CT值低于-950 HU的容积/肺叶容积）。采用Spearman相关分析各级支气管定量参数与EI、肺功能的相关性。结果第4级支气管各定量参数与肺功能均无明显相关性（P〉0.05）,而第5、6级支气管的WA%mean与第1秒用力呼气量（FEV1）、第1秒用力呼气量的实测值与预测值的百分比（FEV1%）呈负相关（P〈0.05）,且相关系数随着支气管管径的变小而增加。在右肺上叶水平,第6级支气管WA%mean与右肺上叶EI呈正相关（r=0.66,P=0.02）,左肺下叶水平第6级支气管LDmean与左肺下叶EI呈负相关（r=-0.66,P=0.01）。结论 MSCT定量成像能有效评价COPD小气道重塑及肺气肿,且肺气肿程度与小气道重塑有一定相关性。Objective To quantitatively analyze small airway remodeling and lobe-based emphysema index,and to explore correlation between the quantitative parameters of the small airways and pulmonary function,emphysema index with MSCT in chronic obstructive pulmonary disease（COPD）patients.Methods Sixty COPD patients underwent inspiratory phase MSCT scan after pulmonary function test（PFT）.The software automatically calculated the emphysema index,which was defined as the percentage of lung voxels less than-950 HU at inspiratory CT at lobe level.Quantitative assessment of airway dimensions was performed in the fourth（segmental）,fifth,and sixth（subsegmental）generations of the following bronchial pathways,RB1（apical segment of the right upper lobe）,RB4（lateral segment of the right middle lobe）,RB10（posterobasal segment of the right lower lobe）,LB1（apicoposterior segment of the left upper lobe）,and LB10（posterobasal segment of the left lower lobe）.Each airway parameters,including wall thickness,luminal diameter and wall area percentage,were measured.Then,the mean value of the measured dimensions of the fourth,fifth,and sixth generations of bronchi in a given segmental pathway was calculated.The Spearmanrank test was used to assess the correlation of small airway parameters with PFT and lobe-based emphysema.Results No significantly correlation was found between small airway parameters of the fourth generations of bronchi and PFT（P〉0.05）.However,there was negative correlation between mean wall area percent（WA%mean）of fifth,sixth generations of bronchi and forced expiratory volume at 1second（FEV1）,FEV1%.WA%meanof the sixth generations of bronchi positively correlated with emphysema index（EI）on right upper lobe level（r=0.66,P=0.02）.LDmeanof the sixth generations of bronchi positively correlated with EI on left lower lobe（r=-0.66,P=0.01）.Conclusion MSCT imaging can quantitatively evaluate small airway remodeling and emphysema in COPD patients,and the degree of emphysema hav

关 键 词：肺疾病 慢性阻塞性 肺气肿 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563.3[医药卫生—放射医学]