慢性阻塞性肺疾病急性加重期患者CT肺血管参数与肺功能及预后相关性分析  

Correlation between CT pulmonary vascular parameters and pulmonary function,prognosis in AECOPD patients

作　　者：周璇[1] 邹娟[1] 谢莉[1] 寇咏 ZHOU Xuan;ZOU Juan;XIE Li;KOU Yong(Department of General Respiratory,West China Hospital,Sichuan University,Chengdu 610044,China)

机构地区：[1]四川大学华西医院呼吸综合科,四川成都610044

出　　处：《陕西医学杂志》2023年第5期587-590,617,共5页Shaanxi Medical Journal

基　　金：四川省科技计划项目(2018SZ0240)。

摘　　要：目的:探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者CT肺血管参数与肺功能及预后的相关性。方法:选取146例AECOPD患者作为AECOPD组,选取同期健康体检者85例作为CR组,比较两组CT肺血管参数[肺小血管面积百分比(%CSA)、肺动脉和主动脉直径比值(PA/A)]、肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积与用力肺活量的百分比(FEV1/FVC)],并分析其与预后的相关性。结果:AECOPD组%CSA、FVC、FEV1、FEV1/FVC水平低于CR组,PA/A水平高于CR组(均P<0.05);Pearson相关性分析显示,%CSA与FVC、FEV1、FEV1/FVC呈正相关,PA/A与FVC、FEV1、FEV1/FVC呈负相关(均P<0.05);生存组%CSA水平高于死亡组,PA/A水平低于死亡组(均P<0.05);ROC曲线分析显示,%CSA、PA/A联合预测AECOPD患者预后的AUC为0.871,高于%CSA的0.770,PA/A的0.784(均P<0.05);采用二元Logistic回归分析,年龄>60岁(OR=4.181,P=0.003)、糖尿病(OR=4.412,P=0.010)、GOLD分级Ⅲ-Ⅳ级(OR=3.050,P=0.019)、%CSA≤1.57%(OR=2.965,P=0.020)、PA/A>0.94(OR=3.967,P=0.005)均为AECOPD患者预后的独立危险因素(P<0.05)。结论:AECOPD患者CT肺血管参数与肺功能及预后有相关性,%CSA≤1.57%、PA/A>0.94是AECOPD患者预后的独立危险因素。Objective:To explore the correlation between CT pulmonary vascular parameters and pulmonary function,prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 146 patients with AECOPD were enrolled as AECOPD group,while 85 healthy controls during the same period were enrolled as CR group.CT pulmonary vascular parameters[percentage of pulmonary small vessel area(%CSA),ratio of pulmonary artery to aorta diameter(PA/A)]and pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC]were compared between the two groups,and their correlation with prognosis was analyzed.Results:The levels of%CSA,FVC,FEV1 and FEV1/FVC in AECOPD group were lower than those in CR group,while PA/A was higher than that in CR group(all P<0.05).Pearson correlation analysis showed that%CSA was positively correlated with FVC,FEV1 and FEV1/FVC,while PA/A was negatively correlated with them(all P<0.05).%CSA in survival group was higher than that in CR group,while PA/A level was lower than that in CR group(all P<0.05).ROC curve analysis showed that the AUC of%CSA combined with PA/A in predicting the prognosis of AECOPD patients was 0.871,higher than that of%CSA(0.770)and PA/A(0.784)(all P<0.05).Binary Logistic regression analysis showed that age>60 years(OR=4.181,P=0.003),diabetes mellitus(OR=4.412,P=0.010),GOLD grading at gradeⅢ-Ⅳ(OR=3.050,P=0.019),%CSA≤1.57%(OR=2.965,P=0.020)and PA/A>0.94(OR=3.967,P=0.005)were independent risk factors of prognosis in patients with AECOPD.Conclusion:CT pulmonary vascular parameters are correlated with pulmonary function and prognosis in AECOPD patients.%CSA≤1.57%and PA/A>0.94 are independent risk factors of prognosis in AECOPD patients.

关 键 词：慢性阻塞性肺疾病 计算机断层扫描 肺小血管面积 肺动脉和主动脉直径比值 肺功能 预后 

分 类 号：R563.9[医药卫生—呼吸系统]