胸部高分辨率CT结合肺功能最大中期呼气流量/用力肺活量比值、呼出气一氧化氮水平对慢性阻塞性肺疾病风险人群的预测价值  

Predictive value of chest high-resolution CT combined with MMEF/FVC and FeNO level in patients at risk of COPD

作　　者：冯海军 贺航咏 练越阳 郭晓娟 杨媛华 Liu Yuewu Feng Haijun;He Hangyong;Lian Yueyang;Liu Yuewu;Guo Xiaojuan;Yang Yuanhua(Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院,北京市呼吸疾病研究所呼吸与危重症医学科,北京100020

出　　处：《中国医刊》2024年第3期265-270,共6页Chinese Journal of Medicine

基　　金：国家重点研发计划(2023YFC2507200);2023北京市呼吸疾病研究所预算编制项目(Ysbz2023003);国家重点研发计划(2016YFC1304402)。

摘　　要：目的探索胸部高分辨率CT气道壁厚度、肺气肿容积结合肺功能最大中期呼气流量(MMEF)/用力肺活量(FVC)比值(MMEF/FVC)、呼出气一氧化氮(FeNO)水平在慢性阻塞性肺疾病(COPD)风险人群中的早期诊断价值。方法纳入2018年1月至2022年12月在首都医科大学附属北京朝阳医院呼吸与危重症医学科就诊的320例患者作为研究对象,根据病史、症状及肺功能情况分为COPD稳定期组(100例)、COPD风险组(102例)和对照组(118例),比较三组患者的胸部高分辨率CT气道壁厚度、肺气肿容积、MMEF/FVC和FeNO水平并探讨其对COPD高风险人群的早期诊断价值。结果对照组、COPD风险组、COPD稳定期组气道壁厚度、FeNO水平、胸部高分辨率CT全肺CT值低于-950HU的肺容积百分比依次增高,MMEF/FVC依次降低,组间比较差异均有统计学意义(P<0.001)。FeNO水平对COPD风险人群的早期诊断价值较高(AUC=0.657,95%CI 0.583~0.731),气道壁厚度及全肺CT值低于-950HU的肺容积百分比对COPD风险人群的早期诊断也具有一定价值。结论应用肺功能指标MMEF/FVC和FeNO水平,结合胸部高分辨率CT中全肺CT值低于-950HU的肺容积百分比和气道壁厚度等指标,可用于临床早期识别COPD风险人群。Objective To explore the predictive value of small airway wall thickness and emphysema volume in chest CT combined with MMEF/FVC and FeNO level in early identification of patients at risk of COPD.Method A total of 320 patients from the department of respiratory and critical care medicine of Beijing Chaoyang Hospital from January 2018 to December 2022 were included in the study,and then divided into control group(n=118),COPD risk group(n=102)and stable COPD group(n=100).The small airway wall thickness,emphysema volume in chest high-resolution CT,MMEF/FVC,and FeNO were compared between the three groups.Result MMEF/FVC,FeNO,the percentage of whole lung CT values below-950HU and mean airway wall thickness of COPD risk group were significantly higher than that in the control group.There were significant differences in MMEF/FVC,FeNO,small airway wall thickness and percentage of whole lung CT values below-950HU between the three groups(P<0.001).In the control group,COPD risk group and stable COPD group,small airway wall thickness,the percentage of whole lung CT values below-950HU,and FeNO showed an increasing trend,and MMEF/FVC showed a trend of decreasing.FeNO had a good diagnostic efficacy in identifying patients at risk of COPD(AUC=0.657,95%CI 0.583-0.731),and airway wall thickness and the percentage of whole lung CT values below-950HU were also capable of predicting patients at risk of COPD.Conclusion For patients at risk of COPD,the application of pulmonary function indicators such as MMEF/FVC and FeNO,combine with the percentage of whole lung CT value below-950HU and airway wall thickness in chest high-resolution CT,may be a useful method to improve the early clinical recognition.

关 键 词：胸部高分辨率CT 肺气肿容积 最大中期呼气流量 用力肺活量 呼出气一氧化氮 慢性阻塞性肺疾病 预测价值 

分 类 号：R563[医药卫生—呼吸系统]