肺低衰减区比例及胸大肌参数评估老年慢性阻塞性肺疾病患者肺通气功能受损的临床研究  

Clinical Study on Low Attenuation Area Ratio and Pectoral Major Parameters in Evaluating Severity of Pulmonary Ventilation Function Impairmentin Elderly Patients with COPD

作　　者：王亚林 张静 朱慕云 WANG Yalin;ZHANG Jing;ZHU Muyun(Department of Geriatric Medicine,North Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院老年医学科,江苏省扬州市225001

出　　处：《中国全科医学》2022年第27期3358-3364,共7页Chinese General Practice

摘　　要：背景老年慢性阻塞性肺疾病患者肺低衰减区比例(LAA%)及胸大肌参数与肺通气功能具有相关性,目前国内外研究较少。目的分析老年慢性阻塞性肺疾病患者LAA%及胸大肌参数与肺通气功能受损的相关性,并探讨其对气流受限严重程度的预测价值,以期为临床早期发现及诊断慢性阻塞性肺疾病提供临床依据。方法选择自2019年12月至2021年6月在扬州大学附属苏北人民医院完成胸部CT及肺功能检查的稳定期老年慢性阻塞性肺疾病患者270例,根据GOLD分级分为GOLDⅠ级组〔第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)≥80%,n=47〕、GOLDⅡ级组(50%≤FEV_(1)%pred<80%,n=88)、GOLDⅢ级组(30%≤FEV_(1)%pred<50%,n=84)、GOLDⅣ级组(FEV_(1)%pred<30%,n=51),收集患者一般资料及CT定量指标,采用Pearson相关分析及多元线性回归分析探究LAA%、胸大肌参数与肺功能的关系。应用受试者工作特征曲线(ROC曲线)探讨LAA%及胸大肌面积(PMcsa)对FEV_(1)%pred<50%及FEV_(1)%pred<80%的预测价值。结果GOLDⅠ级组体质指数(BMI)、胸大肌密度(PMD)均高于GOLDⅢ级组和GOLDⅣ级组(P<0.05),GOLDⅡ级组、GOLDⅢ组BMI高于GOLDⅣ组(P<0.05);GOLDⅠ级组PMcsa、胸大肌指数(PMI)、FEV_(1)%pred、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)均高于GOLDⅡ级组、GOLDⅢ级组、GOLDⅣ级组(P<0.05),GOLDⅡ级组PMcsa、PMI、FEV_(1)%pred、FEV_(1)、FVC均高于GOLDⅢ级组、GOLDⅣ级组(P<0.05),GOLDⅢ级组PMcsa、PMI、FEV_(1)%pred、FEV_(1)、FVC均高于GOLDⅣ级组(P<0.05);GOLDⅠ级组左肺LAA%、右肺LAA%、总肺LAA%低于GOLDⅡ级组、GOLDⅢ级组、GOLDⅣ级组(P<0.05),GOLDⅡ级组左肺LAA%、右肺LAA%、总肺LAA%低于GOLDⅢ级组、GOLDⅣ级组(P<0.05),GOLDⅢ级组左肺LAA%、右肺LAA%、总肺LAA%低于GOLDⅣ级组(P<0.05)。FEV_(1)%pred、FEV_(1)、FVC均与PMcsa、PMI、PMD呈正相关(P<0.05)。FEV_(1)%pred、FEV_(1)均与右肺LAA%、左肺LAA%、总肺LAA%呈负相关(P<0.0Background Low attenuation area ratio(LAA%)and pectoral major parameters are in elderly patients with COPD related to pulmonary ventilation function,but there are few studies at home and abroad.Objective To analyze the correlation of LAA%and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD,and to explore the predictive value of LAA%and PMcsa in the severity of airflow restriction,in order to provide clinical basis for the early detection and diagnosis of COPD.Methods A total of 270 elderly patients with stable COPD who underwent chest CT and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June 2021 were selected and divided into GOLDⅠgroup(FEV_(1)%pred≥80%,n=47),GOLDⅡgroup(50%≤FEV_(1)%pred<80%,n=88),GOLDⅢgroup(30%≤FEV_(1)%pred<50%,n=84)and GOLDⅣgroup(FEV_(1)%pred<30%,n=51)according to GOLD classification with their general information and CT quantitative indexes recorded.Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between LAA%,pectoralis major areas(PMcsa)and lung function.The receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of LAA%and PMcsa for FEV_(1)%pred<50%and FEV_(1)%pred<80%.Results BMI and PMD in GOLDⅠgroup were higher than those in GOLDⅢgroup and GOLDⅣgroup(P<0.05),and the BMI in GOLDⅡgroup and GOLDⅢgroup was higher than that in GOLDⅣgroup(P<0.05).PMcsa,PMI,FEV_(1)%pred,FEV_(1) and FVC in GOLDⅠgroup were higher than those in GOLDⅡgroup,GOLDⅢgroup and GOLDⅣgroup(P<0.05).PMcsa,PMI,FEV_(1)%pred,FEV_(1) and FVC in GOLDⅡgroup were higher than those in GOLDⅢgroup and GOLDⅣgroup(P<0.05).PMcsa,PMI,FEV_(1)%pred,FEV_(1) and FVC in GOLDⅢgroup were higher than those in GOLDⅣgroup(P<0.05).Left lung LAA%,right lung LAA%and total lung LAA%in GOLDⅠgroup were lower than those in GOLDⅡgroup,GOLDⅢgroup and GOLDⅣgroup(P<0.05).Left lung LAA%,right lun

关 键 词：肺疾病 慢性阻塞性 老年人 呼吸功能试验 体层摄影术 螺旋计算机 影响因素分析 预测 

分 类 号：R563.9[医药卫生—呼吸系统]