慢性阻塞性肺疾病HRCT分型及CT定量研究  

Characteristics of COPD phenotypes classified according to the HRCT and Quantitative CT research

作　　者：刘勇彬[1] 陈淮[1] 曾庆思[1] 陈利娜[1] 李雯[1] 郑劲平[2,3] 

机构地区：[1]广州医科大学附属第一医院放射科,510120 [2]广州呼吸疾病研究所,510120 [3]广东医学院附属厚街医院CT室,东莞529945

出　　处：《现代医用影像学》2017年第3期575-580,共6页Modern Medical Imageology

基　　金：广东省科技厅科技计划项目(项目编号:2014A020212608)资助

摘　　要：目的:探讨HRCT评价COPD的方法,根据影像学表现及对COPD进行HRCT分型,研究COPD各型与肺功能、临床特征的关系。资料与方法:搜集2009年1月至2011年1月广州医科大学附属第一医院的108位COPD患者,1级31例,2级39例,3级26例,4级12例。行双相扫描,主要根据支气管管壁增厚情况及肺气肿程度进行分型。结果:COPD患者分为5种类型:A型28例,M1型19例,M2型12例,E1型35例,E2型14例。A型、E1型患者的体重指数分别高于E2型、M1型、M2型,各型间差异有统计学意义。不同分型中吸烟指数差异无统计学意义,不同分级近6个月急性加重频率差异有统计学意义。A型患者的FEV1%、FEV1/FVC优于其他各型,各型间差异有统计学意义。M2型患者的残气量、残总比高于其他各型,差异有统计学意义。各型患者肺总量间的差别无统计学意义。在吸气、呼气相CT肺功能各项检查指标中:A型高于其他各型,差异有统计学意义;E2型患者肺气体总容积中大于其他各型,差异有统计学意义;A型患者单位体积密度最大,各型间差异有统计学意义;E2型患者肺气肿容积高于其他各型,差异有统计学意义。结论:COPD可分为5种类型,各型间的临床特征、常规肺功能、CT肺功能各项指标不同,可对临床进一步的个体化治疗有积极的指导意义。Objective： To classify the high-resolution CT（ HRCT） phenotypes of COPD,and to investigate the clinical characteristics of various phenotypes and the relationship with pulmonary function tests and clinical features.Methods：Collections of 108 COPD patients admitted to the First Affiliated Hospital of Guangzhou Medicial University,Guangzhou Institute of Respiratory Diseases in January 2009 to January 2011. 31 cases belonged to level 1,39 cases belonged to level 2,26 cases belonged to level 3,12 cases belonged level 4. At the end of maximum inspiratory and maximum end-expiratory breath-hold scan,were classified according to the degree of bronchial wall thicking in HRCT images and CT pulmonary function tests in emphyseme. Results： COPD patients were classified into 5 phenototypes： Phenotype A,28 cases; Phenotype M1,19 cases; Phenotype M2,12 cases; Phenotype E1,35 patients; Phenotype E2,14 cases. Patients with phenotype A and E1 showed a higher body mass index vs phenotype E2 、M1 and M2. The FEV1% and FEV1/FVC in phenotype A were better than other each model,the difference was statistically significant. The RV in phenotype M2 was the largest,the difference was statistically significant. The RV/TLC in phenotype M2 was higher than other each model. No significant difference between the group of patients with TLC. Inhale and exhale in phase CT lung function in the check index： phenotype A patient lung CT,respectively,in an average HU,higher than other each model. E2 phenotype gas in the lungs total volume,more than any other each model; Patients with phenotype A unit volume density maximum; E2 phenotype patients respectively emphysema volume,higher than other each model. Conclusion： Various morphological phenotypes of COPD based on HRCTshowed different clinical characteristics 、Conventional lung function,CT lung function.

关 键 词：肺疾病 慢性阻塞性 体层摄影术 X线计算机 分型 肺功能检查 

分 类 号：R563.9[医药卫生—呼吸系统] R816.41[医药卫生—内科学]