基于CT双气相定量评估慢性阻塞性肺疾病患者小气道病变和肺气肿程度的临床价值  

Clinical value of quantitative evaluation of small airway lesions and emphysema degree in patients with chronic obstructive pulmonary disease based on CT biphasic imaging

作　　者：邢芳远 郭小霞 武瑞华 郭瑞霞[1] XING Fangyuan;GUO Xiaoxia;WU Ruihua;GUO Ruixia(the Second Department of Respiratory and Critical Care Medicine,Handan First Hospital,Handan,Hebei 056002,China)

机构地区：[1]邯郸市第一医院呼吸与危重症医学二科,河北邯郸056002

出　　处：《临床肺科杂志》2023年第12期1836-1840,共5页Journal of Clinical Pulmonary Medicine

基　　金：邯郸市科学技术局(No.21422083064)。

摘　　要：目的探讨基于CT双气相定量评估慢性阻塞性肺疾病(COPD)患者小气道病变(fSAD)和肺气肿(Emph)程度的临床价值。方法选择2019年1月-2022年12月邯郸市第一医院接诊的COPD患者118例的数据资料回顾性分析。对比轻度组[慢性阻塞性肺疾病全球倡议(GOLD)Ⅰ级和Ⅱ级]和重度组(GOLDⅢ级和Ⅳ级)患者的一般临床情况指标、肺功能(PFT)检查指标、不同肺叶的fSAD比例情况、不同肺叶的Emph比例情况。分析PFT检查指标同fSAD、Emph的相关性。结果纳入研究的患者中,轻度组有68人,重度组有50人。两组患者的年龄、性别、体质指数、吸烟情况的数据差异无统计学意义(均P>0.05)。重度组患者的COPD病程高于轻度组(P<0.05)。重度组患者的第1秒用力呼气容积占预计值的百分比(FEV_(1)%)、FEV_(1)占用力肺活量的百分比(FEV_(1)/FVC)、峰值呼吸流速百分比(PEF%)、肺一氧化碳弥散量(D LCO)均低于轻度组患者(均P<0.05)。重度组患者左肺下叶,左肺上叶,右肺上叶,右肺中叶,右肺下叶的fSAD比例、Emph比例均高于轻度组患者(均P<0.05)。全部入组患者的FEV_(1)、FEV_(1)/FVC、PEF%、D LCO和fSAD、Emph之间呈负相关(均P<0.05)。结论利用CT双气相定量的方法测评COPD患者的fSAD和Emph程度,对于区分患者的病变严重程度具有良好的价值,而且fSAD和Emph两种指标和肺功能检测指标之间也具有良好的相关性,值得深入挖掘分析。Objective To explore the clinical value of quantitative assessment of small airway lesions(fSAD)and emphysema(Emph)in patients with chronic obstructive pulmonary disease(COPD)based on CT biphasic imaging.Methods A retrospective analysis was conducted on the data of 118 COPD patients admitted to the First Hospital of Handan City from January 2019 to December 2022.Their general clinical condition indicators,lung function examination(PFT)indicators,fSAD ratio in different lobes,and Emph ratio in different lobes of patients were compared between the mild group(Global Initiative for Chronic Obstructive Pulmonary Disease(GOLD)ClassⅠandⅡ)and the severe group(GOLD ClassⅢandⅣ).The correlation between PFT examination indicators and fSAD and Emph was analyzed.Results There were 68 patients in the mild group and 50 in the severe group.There was no significant differences in age,sex,body mass index and smoking status between the two groups(all P>0.05).The course of COPD in the severe group was higher than that in the mild group(P<0.05).The percentage of forced expiratory volume in the first second to the predicted value(FEV_(1)%),percentage of forced vital capacity(FEV_(1)/FVC),percentage of peak respiratory flow rate(PEF%)and lung carbon monoxide dispersion(D LCO)in the severe group were all lower than those in the mild group(all P<0.05).The proportions of fSAD and Emph in the left lower lobe,left upper lobe,right upper lobe,right middle lobe and right lower lobe of the severe group were higher than those in the mild group(all P<0.05).FEV_(1),FEV_(1)/FVC,PEF%,and D LCO were negatively correlated with fSAD and Emph in all patients(all P<0.05).Conclusion The use of CT dual gas phase quantitative ethod to evaluate the fSAD and Emph levels in COPD patients has good value in distinguishing the severity of the disease,and there is also a good correlation between fSAD and Emph indicators and lung function detection indicators,which is worth further exploration and analysis.

关 键 词：慢性阻塞性肺疾病 小气道病变 肺气肿 肺功能检查 肺叶 

分 类 号：R563[医药卫生—呼吸系统] R816.4[医药卫生—内科学]