探讨不同肺叶定量CT参数在慢性阻塞性肺疾病评估中的价值  

Quantitative CT parameters of different lung lobe segmentation in assessment of chronic obstructive pulmonary disease

作　　者：吴兴贵 张博[2] 连一新[1] 高士媛 施敏骅[1] 徐亮[2] 范国华[2] WU Xinggui;ZHANG Bo;LIAN Yixin;GAO Shiyuan;SHI Minhua;XU Liang;FAN Guohua(Department of Respiratory,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Radiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院呼吸科,江苏苏州215004 [2]苏州大学附属第二医院影像科,江苏苏州215004

出　　处：《南京医科大学学报（自然科学版）》2020年第3期396-402,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：苏州市医学重点学科(SZXK201506)。

摘　　要：目的:研究肺叶定量CT参数在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病情评估中的意义。方法:纳入102例行胸部CT及肺功能检查的稳定期COPD患者。肺功能检测指标包括用力肺活量(forced expiratory volume,FVC)及其占预计值百分比(FVC%pred)、第1秒用力呼气容量(forced expiratory volume in one second,FEV1)及其占预计值的百分比(FEV1%pred)、第1秒率(FEV1/FVC)、最大分钟通气量(maximum ventilatory volume,MVV)及其占预计值百分比(MVV%pred)、最大呼气中期流量(maximum mid expiratory flow,MMEF)。测量CT图像中各肺叶低于-950 HU密度区容积百分比(low attenuation area percentage,LAA%)、分段肺叶主气道直径、分段肺叶主气道壁厚度,并进行统计学分析。结果:定量CT参数与肺通气功能指标呈线性负相关(P<0.001);左肺下叶LAA%取值13.5%时,预测MVV%pred<50%和FEVI%pred<50%的灵敏度分别为66.2%、75.0%,特异度为88.4%、81.0%;左肺下叶气道壁厚度预测FEV1%pred<50%的截点值为3.35 mm,其灵敏度和特异度分别为60.5%、72.9%;LAA%联合气道测量值可以解释42%的FEV1%pred,52%的FEV1/FVC,31%的MMEF和35%的MVV%pred指标的变化。结论:COPD患者不同肺叶的定量CT参数能反映其肺功能的变化,并能预测气流受限的严重程度。Objective:This study aims to investigate the significance of lung lobe quantitative CT parameters in assessment of chronic obstructive pulmonary disease(COPD).Methods:Total 102 patients with stable COPD were recruited,and performed with chest CT scan and pulmonary function tests.The indexes of pulmonary function include forced expiratory volume(FVC)and predicted value percentage(FVC%pred),forced expiratory volume in one second(FEV1)and predicted value percentage(FEV1%pred),first second rate(FEV1/FVC),maximum ventilation volume(MVV)and its percentage in the expected value(MVV%pred),maximum mid expiratory flow(MMEF).The percentages of low attenuation area below-950 HU(LAA%)and airway dimensions in each lung lobe segments were measured quantitatively.Results:Parameters of pulmonary ventilation function were linear negatively correlated with airway indicators(P<0.001).When LAA%of left lower lobe was 13.5%,the sensitivity in prediction of MVV%pred<50%and FEV1%pred<50%was 66.2%and 75.0%,specificity was 88.4%and 81.0%,respectively.Wall thickness of 3.35 mm in left lower lobe had 60.5%sensitivity and 72.9%specificity in the prediction of FEV1<50%.LAA%combined with airway variables could account for proportional changes in FEV1%pred of 42%,FEV1/FVC of 52%,MMEF of 31%,and MVV%pred of 35%,respectively.Conclusion:Quantitative CT parameters of different lung lobe can reflect deterioration of lung function in patients with COPD,and can be applied to predict the severity of airflow limitation.

关 键 词：慢性阻塞性肺疾病 肺功能 定量CT LAA% 

分 类 号：R563[医药卫生—呼吸系统]