肺气肿型慢性阻塞性肺疾病患者肺功能及预后与Goddard评分的相关性分析  

Correlation Analysis of Goddard CT Grade of Emphysema with Pulmonary Function and Prognosis in COPD Patients

作　　者：李瑛[1] 凌芳[1] 胡成平[1] 陆蓉莉[1] 熊曾[1] 

机构地区：[1]中南大学湘雅医院呼吸内科湖南省呼吸疾病临床医疗技术研究中心,湖南长沙410008

出　　处：《中国呼吸与危重监护杂志》2015年第4期327-331,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：十二五国家科技支撑计划(编号:2013BAI09B09)

摘　　要：目的探讨Goddard评分对肺气肿型慢性阻塞性肺疾病(简称慢阻肺)患者综合评估的临床价值。方法随机选取肺气肿型慢阻肺患者150例,使用德国Siemens Difinition 64层螺旋CT机对患者进行肺部扫描,采用Goddard评分对患者的肺气肿程度进行评分分级,同时检测患者的FEV1、FVC、FEV1/FVC、RV、TLC、RV/TLC、DLCO、FEV1%pred、FVC%pred及DLCO%pred,对Goddard评分与肺功能各项参数进行相关性检验,比较不同Goddard评分的肺气肿患者在上一年的住院次数、住院时间、病情严重程度和合并症。结果对150例患者的Goddard评分结果显示,轻度肺气肿型慢阻肺57例,中度肺气肿型慢阻肺53例,重度肺气肿型慢阻肺40例;CT肺气肿Goddard评分与肺容积指标RV、TLC、RV/TLC呈显著正相关(r值分别为0.385、0.349和0.455,P<0.05),与弥散功能指标DLCO和DLCO%pred呈显著负相关(r值分别为-0.771和-0.787,P<0.05);重度肺气肿型慢阻肺患者上一年因急性加重住院1次及以上次数显著多于轻度肺气肿和中度肺气肿患者(2值分别为44.69和25.66,P<0.05);重度肺气肿型慢阻肺患者上一年因急性加重住院时间显著长于轻度肺气肿和中度肺气肿型患者[(13.5±4.2)d比(6.4±3.1)d和(9.0±3.8)d,P<0.05];重度肺气肿型慢阻肺患者上一年患重度慢阻肺急性加重的次数显著高于轻度肺气肿和中度肺气肿患者(2值分别为15.38和7.89,P<0.05)。Goddard评分分级越高,患者合并心力衰竭、缺血性心脏病以及呼吸衰竭的风险越高,差异有统计学意义(P<0.05)。结论 Goddard评分作为一种肺气肿的评估体系与肺功能评价指标相互补充,可以更全面地用于肺气肿型慢阻肺患者病情的综合评估。患者Goddard评分等级越高,慢阻肺急性加重发生的频率和严重程度越高,更易于合并呼吸衰竭、心力衰竭等合并症。Objective To explore the clinical value of Goddard CT grade for comprehensive evaluation of emphysema-type COPD. Methods A total of 150 patients with emphysema-type COPD were recruited in the study. Chest CT scan was performed with German Siemens Difinition 64-slice spiral CT machine. The Goddard scoring of lung CT manifestations was used to grade lung emphysema. Lung function indexes were measured including FEV1,FVC,FEV1/ FVC,RV,TLC,RV / TLC,DLCO,FEV1% pred,FVC% pred and DLCO% pred,etc. The correlation between Goddard scores and pulmonary function indexes were analyzed. The incidence of hospitalizations,length of hospital stay,severity of illness and complications in the previous year were compared between the patients with different Goddard CT grade. Results There were 57 cases of mild emphysema,53 cases of moderate emphysema,and 40 cases of severe emphysema judged by Goddard scoring. The pulmonary Goddard scores were positive correlated with RV,TLC,and RV / TLC which reflecting pulmonary function（ r value was 0. 385,0. 349,0. 455,respectively,all P 0. 05）,and negatively correlated with DLCO and DLCO% pred which reflecting pulmonary diffusing capacity（ r value was- 0. 771,- 0. 787,respectively,P 0. 05）. Compared with the mild and moderate emphysema-type patients,the incidence of hospitalization more than one time due to acute exacerbation was significantly higher（ 2value was 44. 69,25. 66,respectively,P 0. 05）,the average length of hospital stay was significantly longer [（ 13. 5 ± 4. 2） d vs.（ 6. 4 ± 3. 1） d and（ 9. 0 ± 3. 8） d,P 0. 05] in the severe emphysema-type COPD patients. The severe emphysema-type COPD patients suffered from more severe acute exacerbation,and higher incidence of heart failure,ischemic heart disease and respiratory failure than the mild and moderate emphysema-type patients（ P 0. 05）. Conclusions Goddard CT grade in complement with pulmonary function evaluation can provide more comprehensive evaluation of emphysema-type COPD.The higher Goddard score is,th

关 键 词：慢性阻塞性肺疾病 Goddard评分 肺气肿 综合评估 

分 类 号：R563.9[医药卫生—呼吸系统]