HRCT肺小血管面积定量测量与COPD小气道功能的相关性研究  

Quantitative measurement of pulmonary small blood vessel area in COPD using high resolution computed tomography:correlation with small airway function

作　　者：刘霞 郭丹丹[1] 李春平[1] 李睿[1] LIU Xia;GUO Dandan;LI Chunping;LI Rui(Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, P.R.China;Department of Radiology, Sichuan Provincial People's Hospital, Chengdu 610072, P.R.China)

机构地区：[1]川北医学院附属医院放射科,四川南充637007 [2]四川省人民医院放射科,四川成都610072

出　　处：《医学影像学杂志》2022年第2期240-245,共6页Journal of Medical Imaging

基　　金：国家自然科学基金资助项目(编号:81801674);川北医学院博士科研启动基金项目(编号:CBY17-QD03)。

摘　　要：目的探讨高分辨率CT(HRCT)肺小血管面积与肺截面积比值(%CSA)与慢性阻塞性肺疾病(COPD)患者肺部小气道功能的相关性。方法选取我院收治入院的连续性COPD患者105例,同时纳入年龄、性别相匹配健康对照组100例。所有纳入者均接受胸部HRCT扫描及肺功能检查。分析所有纳入者的主要小气道肺功能指标(MMEF%、MEF50.00%及MEF25.00%)及脉冲震荡指标IOS(Z5、R5、R20、Fres、X5)。采用Image图像处理软件测量分析基于HRCT的%CSA参数,包括肺小血管截面积<5 mm^(2)(%CSA_(<5))及5~10 mm^(2)(%CSA_(5-10))。应用独立样本t检验比较COPD组与对照组间肺功能及HRCT参数的差异;采用Spearman相关性分析COPD组%CSA与肺功能小气道指标、IOS指标之间的相关性;最后利用ROC曲线评价%CSA指标评估COPD患者小气道功能障碍的诊断效能。结果COPD组患者小气道肺功能指标(MMEF%、MEF50.00%及MEF25.00%)均较对照组明显降低,且随COPD疾病的严重程度增加而逐渐减小。IOS指标Z5、R5、Fres均较对照组增高,X5降低;不同严重程度COPD组Z5、R5、Fres逐渐增大。COPD组%CSA_(<5)、%CSA_(5-10)较对照组明显降低,且%CSA_(<5)在不同COPD分组患者中也均有明显差异(P<0.05)。COPD患者肺功能小气道肺功能指标(MMEF%、MEF50.00%、MEF25.00%)均与%CSA_(<5)、%CSA_(5-10)呈显著正相关;IOS指标(Z5、R5、Fres)均与%CSA呈负相关(P<0.05)。ROC结果显示%CSA_(<5)及%CSA_(5-10)诊断患者小气道功能障碍的AUC值分别为0.959及0.931;当选择%CSA_(<5)的阈值为0.71%时,诊断COPD患者小气道功能障碍有着较好的敏感性(89.30%)及特异性(93.80%)。结论HRCT肺小血管面积定量测量指标%CSA_(<5)及%CSA_(5-10)与小气道功能有着较好的相关性,并可用于准确评估COPD患者小气道功能障碍,具有较为重要的临床意义。Objective To explore the correlation between the percentage of cross-sectional area of small pulmonary vessels for the lung area(%CSA)in high-resolution CT and the function of small airways in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 105 consecutive COPD patients admitted to our hospital were enrolled into this study.In the meantime,100 age/gender matched healthy cases were served as the control group.All subjects received HRCT and pulmonary function examination.The main small airway pulmonary function indexes(MMEF%,MEF 50.00%and MEF25.00%)and impulse concussion indexes IOS(Z5,R5,R20,Fres,X5)were analyzed.The main small airway pulmonary function indexes(MMEF%,MEF50.00%and MEF25.00%)and impulse concussion indexes IOS(Z5,R5,R20,Fres,X5)were analyzed.The%CSA parameters based on HRCT were measured by Image J image processing software,including pulmonary microvascular cross-sectional area<5 mm^(2)(%CSA_(<5))and 5~10 mm^(2)(%CSA_(5-10)).The differences of lung function and HRCT parameters between COPD and control group were compared by independent sample t-test;The correlation between%CSA and small airway indicators of COPD group was analyzed by Spearman correlation.Receiver operating characteristic analysis(ROC)was performed to determine whether CSA%parameters could be used in discriminating small airway dysfunction in COPD subjects.Results In COPD group,the small airway lung function indexes(MMEF%,MEF50.00%and MEF25.00%)were significantly lower than those in the control group,which was also gradually decreased accompanied by increase of the severity of COPD.Compared with the control group,the IOS indexes Z5,R5 and Fres were higher while X5 was decreased.The Z5,R5 and Fres were gradually increased with increased of severity of COPD.The%CSA_(<5) and%CSA_(5-10) in COPD group were significantly lower than those in the control group,and there were also significant differences in the%CSA_(<5) among different COPD groups(all P<0.05).In COPD patients,the pulmonary function index(MMEF%,MEF5

关 键 词：慢性阻塞性肺疾病 体层摄影术 X线计算机 小气道功能 

分 类 号：R563.3[医药卫生—呼吸系统] R814.42[医药卫生—内科学]