慢性阻塞性肺疾病机械通气患者预后与高分辨率CT肺气肿指数的关系  

Correlations between emphysema quantification and prognosis of chronic obstructive pulmonary disease patients under mechanical ventilation

作　　者：王霞[1] 黄小鲁[1] 李楠[1] 金星 薛克栋[1] WANG Xia;HUANG Xiao-lu;LI Nan;JING Xing;XUE Ke-dong(People＇s Hospital of Xinjiang Uygur Autonomous Region,Ururnqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院,乌鲁木齐830001

出　　处：《内科急危重症杂志》2018年第4期285-288,共4页Journal of Critical Care In Internal Medicine

基　　金：新疆自然科学基金(No:2016D01C113)

摘　　要：目的:评价ICU慢性阻塞性肺疾病机械通气患者预后与高分辨率CT(HRCT)肺气肿指数(LAA%)的关系。方法:选取因COPD急性加重需机械通气的重症COPD患者166例,进行HRCT检查,测定肺气肿指数。统计患者1个月全因死亡率,按随访结果将患者分为死亡组(37例)和存活组(129例)。从病历资料中收集患者的临床特点,进行相关统计学分析。结果:死亡组患者LAA%水平明显高于对照组(18. 9±7. 3 vs 12. 6±5. 9,P <0. 01)。Pearson分析显示LAA%与APACHEⅡ评分(r=0. 315,P <0. 001)、机械通气时间(r=0.184,P=0. 012)、PaCO_2(r=0. 231,P=0. 027)、心率(r=0. 131,P=0. 039)、呼吸(r=0. 152,P=0. 041)呈正相关,与PaO_2(r=-0.361,P=0. 013)、pH(r=-0. 261,P=0. 035)呈负相关。人工受试者工作特征曲线(ROC)分析示:LAA%切值取17. 3%时,对患者1个月全因死亡的诊断效率最高,曲线下面积为0. 789[P=0.000,95%CI(0.715,0. 863)],灵敏度为81. 08%、特异度为65. 83%。传统危险因素联合LAA%可明显提升对患者1个月全因死亡的预测价值。结论:HRCT定量测量的肺气肿指数与ICU慢性阻塞性肺疾病机械通气患者预后具有相关性,可作为判断患者预后的可靠指标。Objective： To investigate the association between emphysema quantification and prognosis of chronic obstructive pulmonary disease（ COPD） patients under mechanical ventilation in ICU.Methods： 166 consecutive hospitalized COPD patients under mechanical ventilation were recruited to take the high-resolution computed tomography（ HRCT） scan,and emphysema extent was qualified by measuring the proportion of low attention area in the whole lung（ LAA%）.Incidence of all-cause mortality during 1 month was observed.The patients were divided into the death group（ n = 37） and the survival group（ n = 129）.The correlation between LAA% and prognosis in patients was analyzed.Results： As compared with the survival group,LAA% was significantly increased in the death group（ 18.9 ± 7.3 vs 12.6 ± 5.9,P 0.01）.LAA% was positively related to chronic health evaluationⅡ（ APACHEⅡ） score（ r = 0.315,P 0.001）,the time of mechanical ventilation（ r = 0.184,P = 0.012）,PaCO2（ r = 0.231,P = 0.027）,heart rate（ r = 0.131,P = 0.039） and respiration（ r =0.152,P = 0.041）,while negatively related to PaO2（ r =-0.361,P = 0.013） and pH（ r =-0.261,P = 0.035）.In a receiver-operating characteristic curve（ ROC） analysis,when the cut off of LAA% was 17.3%,the diagnostic efficiency for prognosis achieved the highest value,the area under the curve was 0.789 [P = 0.000,95% CI（ 0.715,0.863） ],the sensitivity was 81.08%,and the specificity was 65.83%.Meanwhile LAA% had the ability to improve prediction of all-cause mortality beyond traditional risk factors.Conclusion： LAA% can be used as a good diagnostic indicator for prognosis of COPD patients under mechanical ventilation in ICU.

关 键 词：慢性阻塞性肺疾病 肺气肿 高分辨率CT 预后 

分 类 号：R563[医药卫生—呼吸系统]