定量CT测得术后肺功能预测值评估肺叶切除术后肺部并发症的价值  

Postoperative Pulmonary Function Predicted by Quantitative CT in Evaluating Postoperative Pulmonary Complication After Lobectomy

作　　者：徐春艳 犹露 李昌明 彭娟 余虹 李邦国 XU Chunyan;YOU Lu;LI Changming;PENG Juan;YU Hong;LI Bangguo(Department of Radiology,Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China)

机构地区：[1]遵义医科大学附属医院放射科,贵州遵义563003 [2]遵义市中医院影像科,贵州遵义563000

出　　处：《中国医学影像学杂志》2023年第6期600-605,共6页Chinese Journal of Medical Imaging

基　　金：遵义市科技局基金引导项目(遵市科合HZ字〔2019〕59号);国家自然科学基金项目(82060336);贵州省科技支撑计划项目(黔科合支撑〔2021〕一般432);贵州省基础研究计划项目(黔科合基础-ZK〔2021〕一般486)。

摘　　要：目的通过定量CT(QCT)测定功能性肺容积并预测术后肺功能,探讨QCT测得术后肺功能预测值评估肺叶切除术后肺部并发症(PPC)的价值。资料与方法回顾性纳入2019年3月—2020年10月于遵义医科大学附属医院行胸腔镜下肺叶切除术且资料完整的患者151例。收集患者临床资料(年龄、性别、吸烟指数等)、术前肺功能检查指标[第1秒用力呼气量(FEV_(1))、用力肺活量(FVC)、一氧化碳弥散量(DLCO)、第1秒用力呼气量占预计值的百分比(FEV_(1)%pred)、残气量、肺总量(TLC)]及胸部CT图像;分别通过QCT法、解剖分段法计算术后肺功能指标预测值(ppoFEV_(1)、ppoFVC、ppoDLCO等);以PPC发生情况将研究对象分为有PPC组和无PPC组,两组间各参数先行单因素分析,将有统计学意义的指标纳入Logistic回归分析,比较两种方法的受试者工作特征曲线下面积。结果两组年龄、性别、吸烟指数、术前TLC、QCT法术后肺功能指标预测值(ppo_(1)FEV_(1)、ppo_(1)FEV_(1)%pred)及解剖分段法术后肺功能指标预测值(ppo_(2)FEV_(1)、ppo_(2)FEV_(1)%pred)比较,差异有统计学意义(t/χ^(2)/Z=−3.98、14.78、−4.74、−2.02、−4.81、−4.00、−2.46、−2.91,P均<0.05);QCT法的术后肺功能预测值FEV_(1)、FEV_(1)%pred及解剖分段法的术后肺功能指标预测值FEV_(1)%pred是PPC的预测因素(OR=0.07、0.11、0.12,P均<0.05);QCT法的曲线下面积大于解剖分段法(Z=2.86,P<0.05)。结论年龄、性别、吸烟指数、术前肺功能指标TLC是PPC的影响因素;QCT法术后肺功能预测值可作为评估PPC的指标。Purpose To measure functional lung volume and to predict postoperative pulmonary function via quantitative computed tomography(QCT),and to explore the value of QCT for predicting postoperative pulmonary function in evaluating postoperative pulmonary complication(PPC)after lobectomy.Materials and Methods A total of 151 patients who underwent thoracoscopic lobectomy in the Department of Thoracic Surgery of the Affiliated Hospital of Zunyi Medical University from March 2019 to October 2020 were retrospectively collected.Clinical data(such as age,gender,smoking index),preoperative pulmonary function test(PFT)indexes,including forced expiratory volume in the first second(FEV_(1)),forced vital capacity(FVC),diffusion capacity for carbon monoxide(DLCO),percentage of forced expiratory volume in the first second in predicted value(FEV_(1)%pred),residual volume(RV)and total lung capacity(TLC),and chest CT image data were collected.The postoperative pulmonary function predicted values,such as ppoFEV_(1),ppoFVC,ppoDLCO,were measured via QCT and anatomic segmentation approach.All subjects were divided into PPC group and nonPPC group according to the incidence of postoperative pulmonary complication.The parameters between the two groups were analyzed by single factor analysis,and the statistically significant indicators were further included in the Logistic regression analysis.Finally,the area under the ROC curve of the two methods was compared.Results There were significant differences in age,gender,smoking index,preoperative TLC,postoperative pulmonary function indexes predicted by QCT(ppo_(1)FEV_(1),ppo_(1)FEV_(1)%pred)and postoperative pulmonary function indexes predicted by anatomical segmentation(ppo_(2)FEV_(1),ppo_(2)FEV_(1)%pred)between the two groups(t/χ^(2)/Z=−3.98,14.78,−4.74,−2.02,−4.81,−4.00,−2.46,−2.91,respectively,all P<0.05).After binary Logistic regression analysis,the postoperative pulmonary function predictive value of FEV_(1),FEV_(1)%pred via QCT method and the postoperative pulmonary functio

关 键 词：肺切除术 肺容量测定 手术后并发症 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤] R563[医药卫生—临床医学] R445.3