基于双气相定量CT评估COPD患者小气道病变和肺气肿程度的研究  

Evaluation of Small Airway Disease and Emphysema of Patients with COPD Based on Biphasic Quantitative CT

作　　者：赵凡惠 王雷 朱彦瑾 李建龙[1] 郭佑民[1] 黄晓旗 ZHAO Fanhui;WANG Lei;ZHU Yanjin(Department of Radiology,The Affiliated Hospital of Yan'an University,Yan'an 716000,P.R.China)

机构地区：[1]延安大学附属医院影像科

出　　处：《临床放射学杂志》2019年第12期2307-2312,共6页Journal of Clinical Radiology

基　　金：延安市科技攻关计划项目(编号:2018KS-11);延安市科技惠民计划项目(编号:2017-HM-07-01)

摘　　要：目的探讨不同慢性阻塞性肺疾病全球倡议(GOLD)分级慢性阻塞性肺疾病(COPD)患者肺叶内小气道病变和肺气肿的空间分布及其与肺功能的相关性,评估各肺叶的病变情况。方法回顾性分析82例根据肺功能确诊为COPD的患者,按GOLD分级分为4组,1级20例,2级25例,3级21例,4级16例,行吸、呼气双相CT扫描,将数据导入“3D数字肺TM”分析平台,定量分析各肺叶的小气道病变区域百分比(fSAD)、肺气肿区域百分比(Emph)和正常区域百分比(Normal),各肺叶间参数差异用单因素方差分析,均数间两两比较采用LSD方法;fSAD、Emph与肺功能的相关性采用Preason相关性分析法。结果GOLD 1~3级各肺叶fSAD、GOLD 1~2级各肺叶Emph差异有统计学意义(P<0.05)。随着GOLD分级的增高,fSAD和Emph逐渐上升,Normal逐渐减低,GOLD 4级肺叶间参数差异无统计学意义(P>0.05),各肺叶病变程度趋同。fSAD以右肺中叶最显著,Emph以两肺上叶最显著。除右肺上叶(RUL)和右肺中叶(RML)外,各肺叶fSAD与1 s末用力呼气容积实测值占用力肺活量的百分比(FEV1/FVC)均有相关性(P<0.05),两肺下叶fSAD与气流受限(FEV1/FVC)的负相关性较高[右肺下叶(RLL)r=-0.498,P=0.004,左肺下叶(LLL)r=-0.526,P=0.002];各肺叶Emph与FEV1/FVC均有相关性(P<0.05),两肺下叶Emph与气流受限(FEV1/FVC)的负相关性最高(RLL:r=-0.572,LLL:r=-0.606,P均<0.001),除RML和RLL外,各肺叶Emph与DLCO的相关性均有统计学意义(P<0.05),两肺上叶与肺扩散功能障碍(DLCO%)的负相关性较高[RUL:r=-0.623,P=0.001,左肺上叶(LUL):r=-0.535,P=0.002]。结论基于双气相定量CT可反映COPD患者各肺叶损伤程度,根据fSAD和Emph的大小可精准定位病变区域,从而更好地指导临床进行个体化治疗。Objective To investigate the spatial distribution of small airway disease and emphysema in the lungs of pa-tients with different grades of chronic obstructive pulmonary disease and to analysis their correlation with pulmonary func-tion.Assessing the lesions of each lung lobe.Methods Retrospective analysis of 82 patients with COPD diagnosed ac-cording to pulmonary function was done,and patients were dividedinto 4 groups according to the grade of GOLD.There were 20 patients in grade 1,25 patientsin grade 2,21 patientsin grade 3,and 16patientsin grade 4.They underwent biphasic in-spiraition and expiration CT scan,and data was imported into the“3D Digital LungTM”analysis platform to quantitatively analyze the percentage of small airway disease(fSAD),the percentage of emphysema(Emph)and the percentage of nor-mal areas(Normal)in each lung lobe,and the parameterdifferencesbetween the lung lobes were analyzed by one-way ANO-VA.The LSD method was used tocomparethe differencesof eachgroup.The correlations of fSAD or Emph with pulmonary function were analyzed by Preason correlation analysis.Results There were significant differences in the Emph between the each lung lobe of GOLD 1~3 and in fSAD between each lung lobe of GOLD1~2(P<0.05).With the increase of GOLD grade,fSAD and Emph increased but Normal decreasedgradually.There were no significant differences in the parameters of GOLD4 between each lung lobe(P>0.05),and the degree of each lobarlesion was similar.fSAD is most prominent in the right middle lobe,and Emph is most prominent in the upper lobe of both lungs.Except for the right upper lobe and the right middle lobe,there wassignificant correlation between fSAD and FEV1/FVC in each lung lobe(P<0.05),there was a higher negative correlation between fSAD and airflow limitation(FEV1/FVC)in both lower lobes(right lower lobe:r=-0.498,P=0.004,left lower lobe:r=-0.526,P=0.002).There wassignificant correlation between Emph and FEV1/FVCof each lobe(P<0.05),the Emphhad the highest negativecorrelation with airflow limitation(

关 键 词：肺气肿 小气道病变 慢性阻塞性肺疾病 定量CT 

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