CT定量联合肺功能鉴别肺气肿型和支气管炎型慢性阻塞性肺疾病的价值研究  

Study on value of CT quantitative combined with pulmonary function parameters in differentiating emphysema and bronchitis COPD patients

作　　者：叶璐[1] 沈旦[1] 张征宇[1] 潘旭东[1] Lu Ye;Dan Shen;Zheng-yu Zhang;Xu-dong Pan(Department of General Medicine,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215031,China)

机构地区：[1]苏州大学附属第一医院,江苏苏州215031

出　　处：《中国现代医学杂志》2022年第17期73-80,共8页China Journal of Modern Medicine

基　　金：苏州市科技计划项目资助(No:SYS2020098)。

摘　　要：目的分析计算机断层成像(CT)定量联合肺功能鉴别肺气肿型和支气管炎型慢性阻塞性肺疾病(COPD)的价值。方法选取2019年1月—2022年1月苏州大学附属第一医院收治的132例COPD患者作为研究对象(COPD组),其中肺气肿型COPD患者58例、支气管炎型COPD患者74例,另选取同期该院100例健康成年人作为对照组。对所有研究对象进行深吸气末、深呼气末双相CT扫描,收集肺体积、肺血管体积、平均肺密度、低衰减区域(<-950 HU)占肺总体积百分比(LAA%_(-950))等指标,并进行肺功能检查,收集第1秒用力呼气容积实际测量值占预测值百分比(FEV_(1)%pred)、用力肺活量实际测量值占预测值百分比(FVC%pred)、第1秒用力呼气容积与用力肺活量的比值(FEV_(1)/FVC)、一氧化碳弥散量(DLCO)等指标。比较COPD组与对照组基线资料、CT定量和肺功能检查结果;比较2种类型COPD患者CT定量和肺功能指标的差异;绘制受试者工作特征(ROC)曲线分析CT定量和肺功能鉴别2种类型COPD的效能;一致性分析CT定量联合肺功能鉴别2种类型COPD的效能;多因素逐步Logistic回归分析COPD的危险因素。结果与对照组比较,COPD组吸烟史、特殊职业暴露史患者比例较高,并且COPD组肺体积较大,肺血管体积、FEV_(1)%pred、FVC%pred、FEV_(1)/FVC、DLCO值较小(P<0.05);与支气管炎型COPD患者比较,肺气肿型COPD患者肺血管体积、肺密度、LAA%_(-950)值较大(P<0.05);与支气管炎型COPD患者比较,肺气肿型COPD患者FEV_(1)%pred、FVC%pred、FEV_(1)/FVC、DLCO较低(P<0.05);ROC曲线结果显示,肺血管体积≥111.175 mL、平均肺密度≥-841.933 HU、LAA%_(-950)≥34.613、FEV_(1)%pred≤42.787%、FVC%pred≤64.989%、FEV_(1)/FVC≤54.755%、DLCO≤62.159 mmol/(min·kPa)是肺气肿型COPD的最佳截断值;一致性分析结果显示,CT定量联合肺功能鉴别肺气肿型COPD的敏感性为91.38%(53/58)、特异性为91.89%(68/74)、准确性为91.67%(121/132)、κ=0Objective To analyze the value of quantitative computed tomography(CT)combined with pulmonary function parameters in differentiating different types of chronic obstructive pulmonary disease(COPD).Methods A total of 132 COPD patients admitted to our hospital from January 2019 to January 2022 were selected as the research object,including 58 cases of emphysema COPD and 74 cases of bronchitis COPD,and 100 healthy adults were selected as the control group during the same period.Dual-phase CT scans at the end of deep inspiratory and end of deep expiratory were performed on all subjects.Lung volume,pulmonary vascular volume,pulmonary vascular volume,mean lung density,percentage of low attenuation area(<-950 HU)in total lung volume(LAA%_(-950))and other indicators were collected,and lung function was examined.The percentage of the actual measured forced expiratory volume of 1s to the predicted value(FEV_(1)%pred),the percentage of the actual measured forced vital capacity to the predicted value(FVC%pred),the percentage of all expiratory volume of the first second at the two stations of forced expiratory volume(FEV_(1)/FVC),carbon monoxide dispersion(DLCO)and other indicators were collected.The baseline data,CT quantification and pulmonary function examination results of COPD group and control group were compared.The differences of CT quantification and lung function indexes between patients with emphysema COPD and bronchitis COPD were compared.ROC was used to analyze the value of CT quantitative indexes and lung function indexes in distinguishing emphysema and bronchitis COPD.The value of CT quantification combined with lung function index in distinguishing emphysema and bronchitis COPD was analyzed by consistency analysis.The risk factors of COPD were analyzed by conditional Logistic stepwise regression.Results Compared with the control group,the proportion of patients with smoking history and special occupational exposure history was higher in COPD group,and lung volume,pulmonary vascular volume,FEV_(1)%pred,FVC%pred,

关 键 词：慢性阻塞性肺疾病 肺气肿型 支气管炎型 计算机断层扫描 定量分析 肺功能 

分 类 号：R563.3[医药卫生—呼吸系统]