吸烟者多层螺旋CT双呼吸相肺气肿、空气潴留定量及与肺功能的相关性分析  

Quantitative analysis of emphysema and air trapping at inspiratory and expiratory phase multi-slice spiral CT scan in smokers：correlation with pulmonary function test

作　　者：张迪 管宇[1] 范丽[1] 夏艺[1] 刘士远[1] Zhang Di, Guan Yu, Fan Li, Xia Yi, Liu Shiyuan(Department of Imaging, Changzheng Hospital, Second Military Medical University, Shanghai 200003, Chin)

机构地区：[1]第二军医大学长征医院影像科,上海200003

出　　处：《中华医学杂志》2018年第19期1467-1473,共7页National Medical Journal of China

基　　金：国家自然科学基金（81370035,81501470,81501618,81230030）;上海市浦江人才计划（15PJD002）

摘　　要：目的定量分析无症状吸烟者在多层螺旋CT（MSCT）呼吸双相扫描下肺气肿及空气潴留（AT），并探讨其与肺功能的相关性。方法收集2013年9月至2016年9月在第二军医大学长征医院进行体检的72例吸烟者，根据肺功能检查结果分为吸烟慢性阻塞性肺疾病（COPD组）24例和吸烟非COPD组48例，另纳入39名不吸烟且肺功能正常的健康志愿者作为对照组。所有受试者均接受MSCT呼吸双相扫描和肺功能检查。CT肺气肿定量参数包括：深吸气末阈值-950HU以下低衰减区占全肺体积的百分率（LAA％-950）、深吸气末全肺像素cT值直方图上第15百分位点对应的CT值（P15-IN），深呼气末全肺像素CT值直方图上第15百分位点对应的CT值（P15-EX）、呼吸相对容积改变（RVC）及平均肺密度呼吸比值（E／I MLD）。肺功能参数包括：第1秒用力呼气容积实测值占预计值百分率（FEV1％）、FEV。与用力肺活量的比值（FEV1／FVC）、残气量与肺总量比值（RV／TLC）及单位肺泡容积一氧化碳扩散量（OLCO／VA）。运用单因素方差分析或Kruskal—Wallis H检验比较三组间cT定量参数、肺功能指标的差异，采用Spearman相关分析评价CT定量参数与肺功能指标的相关性。结果对照组、吸烟非COPD组及吸烟COPD组间肺气肿参数LAA％-950（三组数值分别为0．5％±0．7％、0．7％±1．2％及2．0％±2．4％）、P15-IN[三组数值分别为（-892±33）、（-905±15）及（-907±22）HU]差异均有统计学意义（均P〈0．05）；肺功能参数FEV1％（三组数值分别为88．4％±8．8％、84．2％±7．5％及82．1％±8．0％）、FEV1／FVC（三组数值分别为78．0％±3．8％、76．6％±4．3％及67．3％±5．5％）、DLCO／VA[三组数值分别为（1．36±0．25）、（1．30±0．22）及（1．21±0．22）mmol·min-1·kPa-1·L-1]、RV／TLC（三组数值分别为49．5％±6．6％、45．9％±6．0％及53．0�Objective To quantify emphysema and air trapping at inspiratory and expiratory phase multi-slice spiral CT（MSCT） scanning in smokers without respiratory symptoms, and analyze the correlation between the CT quantifiable parameters and lung function parameters. Methods A total of 72 smokers, who underwent medical examinations from September 2013 to September 2016 in Changzheng Hospital were enrolled in this research and were divided into two groups：24 smokers with COPD and 48 smokers without COPD. Besides, thirty-nine non-smokers with normal pulmonary function were enrolled as the controls. All subjects underwent double phase MSCT scanning and pulmonary function tests. CT quantifiable parameters of emphysema included the low attenuation area below a threshold of -950 Hounsfield Units （HU） （ LAA% -950 ）, the lowest 15th percentile of the histogram of end-inspiratory attenuation values （ P15-IN ）, the lowest 15th percentile of the histogram of end-expiratory attenuation values （ P15-EX ） , relative volume change （RVC） and the expiratory to inspiratory ratio of mean lung density （E/IMLD）. Pulmonary function parameters included forced expiratory volume in 1 second expressed as percent predicted （ FEV1% ）, forced expiratory volume in one second to forced vital capacity ratio （FEV1/FVC）, residual volume to total lung capacity ratio （RV/TLC） and carbon monoxide diffusion capacity corrected for alveolar volume （DLCO/VA）. The differences of CT quantifiable parameters and pulmonary function parameters among the three groups were analyzed by using one-way analysis of variance or Kruskal-Wallis tt test. The correlation between CT quantifiable parameters and pulmonary function parameters was analyzed by using Spearman＇s correlation analysis. Results The differences of LAA% -950 （the values for the controls, the group of smokers with out COPDand the group of smokers with COPD were 0.5%±0.7%, 0.7% ± 1.2% and 2. 0% ±2.4% respectively）, P15-IN （the values of the three groups

关 键 词：体层摄影术 X线计算机 肺疾病  慢性阻塞性 呼吸功能试验 

分 类 号：R563.9[医药卫生—呼吸系统]