双气相定量CT的肺空气体积比值对吸烟者慢性阻塞性肺病的诊断价值  

Value of lung air volume ratio on biphasic quantitative CT for diagnosing COPD in smokers

作　　者：阴玮灵 沈敏 牛媛 任涛[1] 黄晓旗 李建龙[1] 王明全[2] 郭佑民[1] YIN Wei-ling;SHEN Min;NIU Yuan;REN Tao;HUANG Xiao-qi;LI Jian-long;WANG Ming-quan;GUO You-min(Department of Radiology,Yan’an University Affiliated Hospital,Shaanxi 716000,China)

机构地区：[1]延安大学附属医院影像中心,陕西延安716000 [2]延安大学附属医院介入放射科,陕西延安716000

出　　处：《影像诊断与介入放射学》2023年第1期43-48,共6页Diagnostic Imaging & Interventional Radiology

基　　金：陕西省科技厅重点研发计划一般项目(2021SF-254)。

摘　　要：目的 探究基于双气相定量CT的肺空气体积比值对吸烟者中慢性阻塞性肺疾病(COPD)的诊断价值。方法 前瞻性收集2019年6月~2021年6月接受双气相定量CT扫描吸烟受试者的一般资料及影像学资料,一般资料包括年龄、吸烟指数、身体质量指数(BMI)、一秒用力呼气量占预计值百分比(FEV1%pred)、一秒用力呼气量比用力肺活量(FEV1/FVC)。定量CT参数包括呼、吸气双相肺平均密度(MLD)、肺组织体积、肺空气体积及相应双气相比值。两组间参数比较采用t检验或Mann-Whitney U检验。采用Spearman秩相关分析定量CT指标与肺功能的相关性。通过多元线性回归分析肺组织体积比值和肺空气体积比值对肺平均密度比值(MLD_(ex/in))的影响程度。采用多因素Logistic逐步回归模型筛选COPD的独立影响因素,并通过ROC曲线比较预测概率值与各独立影响因素的诊断效能。结果 共有140例符合条件的受试者被纳入本研究。受试者根据临床诊断被分为COPD组(65例)和非COPD组(75例)。BMI、吸烟指数、MLD_(ex/in)、肺组织体积比值、肺空气体积比值在两组间差异均具有统计学意义(P<0.05)。MLD_(ex/in)、肺组织体积比值、肺空气体积比值与FEV1%pred、FEV1/FVC呈显著相关(r分别为-0.621、-0.579、-0.379、-0.436、-0.616、-0.552,P均<0.05)。多元线性回归显示较肺组织体积比值,肺空气体积比值对MLD_(ex/in)影响程度更大(R2=0.875,Beta分别为-0.311、1.054,P均<0.05)。多因素Logistic回归分析结果显示BMI、吸烟指数、肺空气体积比值是COPD的独立影响因素(OR分别为0.693、1.001、1.017,P均<0.05)。ROC曲线结果显示Logistic回归模型预测概率值曲线下面积(AUC)为0.917,敏感度84.6%,特异度86.7%,均优于各独立影响因素。结论 肺空气体积比值是吸烟者COPD的独立危险因素,与BMI、吸烟指数联合具有较好的诊断效能。Objective To explore value of lung air volume ratio on biphasic quantitative CT for diagnosing chronic obstructive pulmonary disease(COPD) in smokers.Methods A total of 140 smokers were divided into COPD (65) and non-COPD (75) groups according to the clinical diagnosis.The clinical data and biphasic quantitative CT in our hospital from June 2019 to June 2021 were prospectively analyzed.The general data included age,smoking index,body mass index (BMI),forced expiratory volume in one second in percent predicted values (FEV1%pred),FEV1/forced vital capacity (FEV1/FVC).Quantitative CT parameters included mean lung density(MLD),lung tissue volume,lung air volume in expiration and inspiration,and the corresponding biphasic ratio.The parameters between the COPD and non-COPD groups were compared using the t test or Mann-Whitney U test.Spearman’s rank correlation coefficient was used to analyze the correlation between quantitative CT indexes and pulmonary function tests.The effect of lung tissue volume ratio and lung air volume ratio on MLD ratio of expiratory to inspiratory phase (MLD_(ex/in)) was analyzed by multiple linear regression.Multivariate logistic stepwise regression model was used to screen independent influencing factors of COPD,and the receiver operating characteristic(ROC) curves were drawn to compare the diagnostic probability of logistic regression prediction probability and each independent influencing factor.Results There were significant differences between the two groups in BMI,smoking index,MLD_(ex/in),lung tissue volume ratio and lung air volume ratio (P<0.05).MLD_(ex/in)(r=-0.621,-0.579),lung tissue volume ratio (r=-0.379,-0.436) and lung air volume ratio (r=-0.616,-0.552) were significantly correlated (all P<0.05) with FEV1%pred and FEV1/FVC,respectively.Compared with lung tissue volume ratio (Beta=-0.311),lung air volume ratio (Beta=1.054) had a greater influence on the MLD_(ex/in)by multiple linear regression (R~2=0.875,P<0.05).Multivariate logistic regression analysis showed that BMI (OR=0.69

关 键 词：体层摄影术 X线计算机 定量评估 肺空气体积 慢性阻塞性肺疾病 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563[医药卫生—放射医学]