薄层CT对具有COPD高危因素肺功能正常者的肺实质形态及量化评估  

Morphological and volumetric quantitative assessment of lung parenchyma for the patients with normal spirometry but with COPD high risk factors using thin slice CT

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

机构地区：[1]第二军医大学附属长征医院医学影像诊断科,上海200003

出　　处：《实用放射学杂志》2016年第1期28-32,共5页Journal of Practical Radiology

基　　金：国家自然基金面上项目（81370035）;国家自然基金青年基金（81000602）;国家自然基金重点项目（81230030）;上海市生物医药处重大专项项目（1341195）.

摘　　要：目的 总结具有慢性阻塞性肺疾病（COPD）高危因素肺功能正常者的肺部CT形态学特点，评价CT容积量化参数与肺功能指标的相关性，进一步探索有无肺气肿者的临床指标、CT征象间的差异。方法 对35例具有COPD高危因素的肺功能正常者进行薄层CT及肺功能检查。评价肺部CT征象（间隔旁型肺气肿、小叶中心型肺气肿、全小叶型肺气肿、小叶中心型肺结节、线样肺不张、磨玻璃样密度影、间质性炎症、马赛克征和支气管扩张或管壁增厚）的发生率。CT容积定量参数有双肺总容积（TLV），阈值〈-950 HU的肺气肿容积（EV-950）和肺气肿指数（EI-950）。将EI-950〈3%时，定义为无明显肺气肿。Spearman相关分析评价CT容积参数与肺功能指标的相关性；有、无显著肺气肿2组间的临床指标、CT征象的比较运用t检验或Fisher精确检验。结果 35例COPD高危者的CT征象中，出现率最高的前3个征象依次是间隔旁型肺气肿18例（51.43%）、线样肺不张13例（37.14%）和小叶中心型肺气肿11例（31.43%）。肺功能指标肺总量（TLC）与CT容积参数TLV具有中度正相关性（r=0.435, P〈0.05）。对有、无肺气肿2组间的临床指标及CT征象的比较，发现仅第1秒率（FEV1/FVC）在2组间存在差异。结论 COPD高危者的CT征象具有一定的特点，以间隔旁型肺气肿、线样肺不张和小叶中心型肺气肿为主；且不同程度肺气肿的高危者具有相似的CT形态学特点。Objective To summarize CT features of the patients at high risk for COPD with normal spirometry,and to compare the pulmonary function values with CT volumetric parameters, and to explore the difference in clinical data and CT findings between patients with or without emphysema. Methods Thirty five patients at high risk for COPD but with normal spirometry were examined by FFT and CT. Tbe CT findings were assessed including paraseptal emphysema, centrilobular emphysema, panlobuiar emphysema, centrilobular nodules, linear atelectasis, ground glass opacity, interstitial lung disease, mosaic attenuation, and bronchiectasis or bronchial wall thickening. The CT quantitative parameters included total lung volume （TLV）, total emphysema volume （TEV） and emphysema index of threshold of hmg area with attenuation lower than -950 Hounsfield units （EI950）. EI〈3% was defined as no apparent emphysema. Spearman correlation analysis was used to evaluate the correlation between quantitative CT parameters and PFT values, and the, t test was used to compare the difference between patients with or without emphysema. For enumeration data, chi-squared test was used. Results Among the CT features in 35 patients at high risk, more incidence rates occurred in paraseptal emphysema in 18/35 （51.43%）, linear atelectasis in 12g/35 （37.14%） andeentrilobular emphysema in 11/35（31.43%）. TheTLC of PFT was correlated with TLV of CT volumetric parameters （r=0. 435, P〈0.05）. The difference in FEV1/FVC was found between patients with or without emphysema. Conclusion The CT findings in patients at high risk for COPD are characteristic including paraseptal emphysema, linear atelectasis and centrilob ular emphysema. Simiiar CT characteristics can be found in the patients with different emphysematous extent.

关 键 词：慢性阻塞性肺疾病 高危因素 呼吸功能试验 计算机体层成像 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]