多层螺旋CT成像在哮喘患者小气道功能评估中的应用  

Application of multislice spiral CT imaging in assessing small airway function of asthma patients

作　　者：凌丽芳 刘兰英[1] 王兵 徐静[1] 龚晓燕 曾亮[1] LING Lifang;LIU Lanying;WANG Bing;XU Jing;GONG Xiaoyan;ZENG Liang(Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院,江苏南京210029

出　　处：《徐州医科大学学报》2024年第12期919-924,共6页Journal of Xuzhou Medical University

基　　金：江苏省中医院科技项目(Y21025);江苏省中医院科主任学术提升专项项目(Y2022ZR21)。

摘　　要：目的探讨哮喘慢性持续期患者多层螺旋CT(MSCT)成像在小气道功能评估中的价值。方法收集2021年10月—2023年10月在江苏省中医院呼吸科及针灸康复科门诊诊断为哮喘慢性持续期的患者102例,均完成胸部MSCT检查与肺功能检查(PFT)、呼出气一氧化氮(FENO)检查,分析检查指标间的相关性并比较小气道功能障碍(SAD)组和非SAD组间差异,分析MSCT小气道成像对SAD的诊断效能。结果小气道管壁厚度(WT)、管壁厚度与截面直径比值(TDR)及管壁面积与截面总截面积比(WA%)与患者性别、年龄、体重指数(BMI)、病程、FENO均无相关性(P>0.05)。TDR、WA%与肺功能指标第1秒用力呼气量实测值与预测值百分比(FEV1%)、用力肺活量实测值与预测值百分比(FVC%)、1秒率(FEV1/FVC)、呼气峰值流量实测值与预测值百分比(PEF%)、用力呼气25%肺活量的瞬时流量实测值与预测值百分比(PEF25%)、用力呼气50%肺活量的瞬时流量实测值与预测值百分比(PEF50%)、用力呼气75%肺活量的瞬时流量实测值与预测值百分比(PEF75%)、最大呼气中段流量实测值与预测值百分比(MMEF%)均呈显著负相关(P<0.001);WT与PEF25%、PEF50%、PEF75%、MMEF%均呈负相关(P<0.05);WT与FVC%、FEV1%、FEV1/FVC、PEF%无相关性(P>0.05)。吸气末相细支气管炎征象与FENO呈弱正相关(P<0.05)。与非SAD组相比,SAD组哮喘患者年龄、BMI、病程均增长(P<0.05),肺通气功能指标均明显降低(P<0.001)。SAD组MSCT小气道定性指标(吸气末相细支气管炎、呼气末相空气潴留)及定量指标(WT、TDR、WA%)均高于非SAD组(P<0.05);2组间性别及FENO值差异无统计学意义(P>0.05)。小气道WT、TDR、WA%及吸气末相细支气管炎、呼气末相空气潴留征象诊断SAD的ROC曲线显示曲线下面积分别为0.676、0.738、0.748、0.683、0.640,差异有统计学意义(P<0.05)。结论MSCT小气道成像可以较准确评估哮喘患者的小气道功能。Objective To explore the value of multislice spiral CT(MSCT)imaging in evaluating small airway function in patients with chronic persistent asthma.Methods A total of 102 patients who were diagnosed with chronic persistent asthma at Department of Respiration and Department of Acupuncture Rehabilitation in Jiangsu Province Hospital of Chinese Medicine from October 2021 to October 2023 were included.All patients underwent chest MSCT imaging,pulmonary function tests(PFT),and fractional exhaled nitric oxide(FENO)measurements.The correlation between the examination indicators was analyzed,and the differences between the small airway dysfunction(SAD)group and the non-SAD group were compared.The diagnostic efficiency of MSCT small airway imaging for SAD was evaluated.Results The small airway wall thickness(WT),the ratio of wall thickness to cross-sectional diameter(TDR),and the ratio of wall area to total cross-sectional area(WA%)showed no correlation with patient gender,age,body mass index(BMI),disease duration,or FENO(P>0.05).TDR and WA%were significantly negatively correlated with pulmonary function indicators such as the percentage of the measured value to the predicted value for the following pulmonary function parameters:forced expiratory volume in 1 second(FEV1%),forced vital capacity(FVC%),FEV1/FVC ratio(1-second ratio),peak expiratory flow(PEF%),PEF at 25%of forced vital capacity(PEF25%),PEF at 50%of forced vital capacity(PEF50%),PEF at 75%of forced vital capacity(PEF75%)and maximal mid-expiratory flow(MMEF%)(P<0.001).WT was negatively correlated with PEF25%,PEF50%,PEF75%,and MMEF%(P<0.05),but showed no significant correlation with FVC%,FEV1%,FEV1/FVC,or PEF%(P>0.05).The presence of bronchiolitis at end-inspiration was weakly positively correlated with FeNO(P<0.05).Compared with the non-SAD group,the SAD group showed significantly increased age,BMI,and disease duration(P<0.05),with markedly reduced pulmonary ventilation function indicators(P<0.001).The SAD group presented significantly higher than MSCT small air

关 键 词：支气管哮喘 多层螺旋CT 小气道 肺功能 呼出气一氧化氮 小气道功能障碍 

分 类 号：R445.3[医药卫生—影像医学与核医学] R562.2[医药卫生—诊断学]