不同表型慢性阻塞性肺疾病患者功能小气道及肺小血管的CT定量分析研究  

CT quantitative analysis of functional small airway and pulmonary vascular in imaging phenotypes of chronic obstructive pulmonary disease

作　　者：管宇 周秀秀 张迪 夏艺 涂文婷 范丽 刘士远 Guan Yu;Zhou Xiuxiu;Zhang Di;Xia Yi;Tu Wenting;Fan Li;Liu Shiyuan(Department of Radiology,the Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院放射诊断科,上海200003

出　　处：《中华放射学杂志》2023年第10期1061-1067,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81930049,82171926,81871321);科技部重点研发计划(2022YFC2010002,2022YFC2010000);长征青年科普扶持计划(CZQNKP-TYYX-LZ-2022-06)。

摘　　要：目的探讨不同表型慢性阻塞性肺疾病(COPD)患者功能小气道、肺小血管CT参数的差异。方法回顾性分析2018年8月至2020年8月在上海长征医院接受双气相CT检查的COPD患者130例。根据CT图像中患者是否存在肺气肿及支气管壁是否增厚分为3种表型:A型(无或轻微肺气肿,不考虑是否合并支气管壁增厚)、E型(存在明显的肺气肿,不合并支气管壁增厚)和M型(同时存在明显的肺气肿和支气管壁增厚)。定量测量不同表型患者全肺的参数响应图(PRM)及肺血管参数,其中PRM参数包括肺气肿体积(PRMV^(Emphysema))、功能小气道体积(PRMV^(fSAD))、正常部分肺体积(PRMV^(Normal))及其体积百分比(%);肺血管参数包括全肺距胸膜6、9、12、15、18、21、24 mm时的肺血管数量(N)和横截面积<5 mm^(2)小血管数量(N^(-CSA<5))。采用ANOVA或Kruskal-Wallis H检验比较3种表型的PRM及肺血管定量参数的差异,两两比较采用LSD或Bonferroni检验。结果3种表型COPD患者在全肺水平PRMV^(Emphysema)、PRMV^(fSAD)、PRMV^(Emphysema)%、PRMV^(fSAD)%、PRMV^(Normal)%差异均有统计学意义(P<0.05)。其中A型PRMV^(Emphysema)、PRMV^(Emphysema)%、PRM^(fSAD)、PRMV^(fSAD)%均低于E型、M型(P<0.001),而M型与E型COPD患者的PRMV^(Empysema)、PRMV^(Emphysema)%、PRM^(fSAD)、PRMV^(fSAD)%差异无统计学意义(P>0.05)。3种表型在全肺水平距胸膜6 mm的N、N^(-CSA<5)差异有统计学意义(P<0.05),其中M型N、N^(-CSA<5)明显低于A型(P<0.001、0.002);M型与E型N差异无统计学意义(P>0.05),而N^(-CSA<5)差异有统计学意义(P=0.034)。结论双气相定量CT分析可反映不同表型COPD患者功能小气道、肺小血管定量参数变化的异质性特点,为个体化评价及治疗提供客观依据。Objective To explore the differences of functional small airway and pulmonary vascular parameters in chronic obstructive pulmonary disease(COPD)of different imaging phenotypes.Methods One hundred and thirty COPD patients underwent biphasic CT scanning in Shanghai Changzheng Hospital from August 2018 to August 2020 were analyzed retrospectively.The patients were classified into three phenotypes based on the presence of emphysema and bronchial wall thickening on CT images.Phenotype A:no emphysema or mild emphysema,with or without bronchial wall thickening;Phenotype E:obvious emphysema without bronchial wall thickening;phenotype M:significant emphysema and bronchial wall thickening were present.Parametric response map(PRM)and pulmonary vascular parameters were quantitatively measured at the whole lung level.PRM parameters included the volume of emphysema(PRMV^(Emphysema)),the volume of functional small airway(PRMV^(fSAD)),the volume of normal pulmonary parenchyma(PRMV^(Normal))and its volume percentage(%).Pulmonary vascular parameters included the number of vessels(N)and cross-sectional area vessels<5 mm^(2)(N^(-CSA<5))at 6,9,12,15,1821,24 mm distance from the pleura.ANOVA or Kruskal-Wallis H tests were used to compare the differences for PRM and pulmonary vascular parameters among the three phenotypes,and LSD or Bonferroni tests were used for multiple comparisons.Results There were significant differences among the three phenotypes for PRMV^(fSAD),PRMV^(Emphysema),PRMV^(fSAD)%,PRMV^(Emphysema)%,and PRMV^(Normal)%at the whole lung level(P<0.05).PRMV^(Emphysema),PRMV^(Emphysema)%,PRMVFsad,PRMV^(fSAD)%of phenotype A were lower than those of phenotype E and M(P<0.001),while there was no significant difference for PRMV^(Emphysema),PRMV^(Emphysema)%,PRMV^(fSAD),PRMV^(fSAD)%between phenotype E and phenotype M(P>0.05).There were significant differences in N and N^(-CSA<5) that 6 mm distance from the pleura among the three groups(P<0.05).Among them,N and N^(-CSA<5) that 6 mm distance from pleura in phenotype M were signific

关 键 词：肺疾病 慢性阻塞性 体层摄影术 X线计算机 肺血管 参数响应图 

分 类 号：R563.9[医药卫生—呼吸系统] R816.41[医药卫生—内科学]