应用HRCT影像学表型综合评估慢性阻塞性肺疾病严重程度及其与LAA相关性  

Comprehensive assessment of chronic obstructive pulmonary disease with HRCT phenotype and LAA score

作　　者：胡雨禾 陈宜泰 李锐[1] 王凯[1] 徐文慧 许丽梅 杜越 陈新[1] Yu-he Hu;Yi-tai Chen;Rui Li;Kai Wang;Wen-hui Xu;Li-mei Xu;Yue Du;Xin Chen(Department of Respiratory and Critical Care Medicine,Zhujiang Hospital of Southern Medical University,Guangzhou,Guangdong 510282,China;Department of Biostatistics,School of Public Health,Southern Medical University,Guangzhou,Guangdong 510515,China)

机构地区：[1]南方医科大学珠江医院呼吸与危重症医学科,广东广州510282 [2]南方医科大学公共卫生学院生物统计学系,广东广州510515

出　　处：《中国现代医学杂志》2019年第1期80-86,共7页China Journal of Modern Medicine

基　　金：广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(No:LC2016PY032);广州市高校创新创业教育特色活动项目(No:201709T26)

摘　　要：目的探讨高分辨率CT(HRCT)影像学表型与低密度衰减区域(LAA)评分在综合评估慢性阻塞性肺疾病(COPD)严重程度中的作用。方法采用横断面调查的方法,选取2014年6月—2016年12月南方医科大学珠江医院就诊的稳定期COPD患者197例。所有患者均在纳入研究后3 d内完成资料采集,包括基础资料、肺功能、呼吸肌肉功能、症状表现和生活质量、运动能力、营养状态、焦虑抑郁情况及HRCT扫描,并根据HRCT表现分为A、E、M 3种影像学表型,比较不同影像学表型的各项指标,并与LAA评分进行相关性分析。结果 A型50例、E型101例、M型46例,平均LAA评分分别为(2.52±1.73)、(12.34±3.59)和(13.46±3.93)分。A型患者的呼吸困难程度(mMRC)、BODE指数低于E型与M型患者(P<0.05),在FEV1、FEV1占预计值的百分比(FEV1%pred)、FEV1/FVC%、6 min步行试验距离(6 MWD)、最大吸气压(PImax)、最大呼气压(PEmax)、体重指数(BMI)方面则高于其余两型(P <0.05),上述评估指标在E型与M型患者中差异无统计学意义(P>0.05)。LAA评分与FEV1、mMRC、COPD评估测试(CAT)、圣乔治呼吸调查问卷(SGRQ)、6 MWD、PImax、PEmax、去脂体重指数(FFMI)、BMI、BODE相关(P <0.05)。多元线性回归发现BODE、FEV1、BMI是预测LAA评分的影响因素(P <0.05)。结论根据HRCT所划分的不同影像学表型具有不同的临床特征。HRCT分型及LAA评分有助于COPD严重程度评估,为疾病的综合评估提供有益的补充。Objective To explore the role of high-resolution computed tomography (HRCT) phenotype and low-attenuation area (LAA) score system in the comprehensive assessment of severity of COPD.Methods A total of 197 COPD patients (stable stage),including 162 males and 35 females,who were admitted in Zhujiang Hospital,Southern Medical University during June 2014 to December 2016 were involved in this study.Basic information,pulmonary function,respiratory muscle strength,symptoms and quality of life,exercise capacity,nutritional status,anxiety and depression,and HRCT scans were recorded.Patients were classified as phenotype A,E and M based on HRC scan.Correlation analysis of clinical regression with LAA score or phenotypes were performed.Results 197 subjects were divided into three phenotypes based on HRCT scan:50 subjects in phenotype A,101 subjects in phenotype E,and 46 subjects in phenotype M.The mean LAA scores in phenotype A,phenotype E,and phenotype M were (2.52±1.73),(12.34±3.59),(13.46±3.93),respectively.The dyspnea severity (mMRC) and BODE index were decreased while FEV1,percent-of-predicted FEV1 (FEV1% pred),FEV1/FVC%,6-min walking distance (6MWD),maximal inspiratory pressure (PImax),maximal expiratory pressure (PEmax) and body mass index (BMI) were increased significantly in phenotype A when compared with those in phenotype E and phenotype M(P<0.01).There was no significant difference in the above parameters between phenotype E and phenotype M(P>0.05).The LAA scores was positively correlated with FEV1,mMRC,COPD Assessment test (CAT),St George’s Respiratory Questionnaire (SGRQ),6 MWD,PImax,PEmax,fat-free body mass index (FFMI),BMI and BODE index (P<0.001).Multiple linear regression analysis suggested that BODE index,FEV1,and BMI were independent risk of LAA scores (P<0.01).Conclusions HRCT based phenotyping of COPD patients and LAA scores may play a role in comprehensive assessment of the severity of COPD.

关 键 词：肺疾病 慢性阻塞性 高分辨率CT表型/X线影像增强 低密度衰减区域 综合评估 

分 类 号：R563.3[医药卫生—呼吸系统]