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吸烟者多层螺旋CT双呼吸相肺气肿、空气潴留定量及与肺功能的相关性分析

Quantitative analysis of emphysema and air trapping at inspiratory and expiratory phase multi-slice spiral CT scan in smokers:correlation with pulmonary function test

摘要:

目的 定量分析无症状吸烟者在多层螺旋CT(MSCT)呼吸双相扫描下肺气肿及空气潴留(AT),并探讨其与肺功能的相关性.方法 收集2013年9月至2016年9月在第二军医大学长征医院进行体检的72例吸烟者,根据肺功能检查结果分为吸烟慢性阻塞性肺疾病(COPD组)24例和吸烟非COPD组48例,另纳入39名不吸烟且肺功能正常的健康志愿者作为对照组.所有受试者均接受MSCT呼吸双相扫描和肺功能检查.CT肺气肿定量参数包括:深吸气末阈值-950 HU以下低衰减区占全肺体积的百分率(LAA%-950)、深吸气末全肺像素CT值直方图上第15百分位点对应的CT值(P15-IN),深呼气末全肺像素CT值直方图上第15百分位点对应的CT值(P15-EX)、呼吸相对容积改变(RVC)及平均肺密度呼吸比值(E/I MLD).肺功能参数包括:第1秒用力呼气容积实测值占预计值百分率(FEV1%)、FEV1与用力肺活量的比值(FEV1/FVC)、残气量与肺总量比值(RV/TLC)及单位肺泡容积一氧化碳扩散量(DLCO/VA).运用单因素方差分析或Kruskal-Wallis H检验比较三组间CT定量参数、肺功能指标的差异,采用Spearman相关分析评价CT定量参数与肺功能指标的相关性.结果 对照组、吸烟非COPD组及吸烟COPD组间肺气肿参数LAA%-950(三组数值分别为0.5%±0.7%、0.7%±1.2%及2.0%±2.4%)、P15-IN[三组数值分别为(-892±33)、(-905±15)及(-907±22)HU]差异均有统计学意义(均P<0.05);肺功能参数FEV1%(三组数值分别为88.4%±8.8%、84.2%±7.5%及82.1%±8.0%)、FEV1/FVC(三组数值分别为78.0%±3.8%、76.6%±4.3%及67.3%±5.5%)、DLCO/VA[三组数值分别为(1.36±0.25)、(1.30±0.22)及(1.21±0.22) mmol·min-1·kPa-1·L-1]、RV/TLC(三组数值分别为49.5%±6.6%、45.9%±6.0%及53.0%±6.4%)差异均有统计学意义(均P<0.05).不吸炯对照组的LAA%950与FEV1/FVC、DLCO/VA(r=-0.32,P=0.04;r=-0.69,P=0.00),P15 IN与FEV1%(r=-0.14,P=0.02)均存在负相关性;P15-IN与DLCO/VA(r =0.55,P=0.00)存在正相关性.吸烟非COPD组的LAA%-950与FEV1/FVC、DLCO/VA(r=-0.31,P=0.04;r=-0.42,P=0.00)均存在负相关性;P15-IN与FEV1/FVC、DLCO/VA(r=0.33,P=0.02;r =0.30,P=0.04)均存在正相关性.吸烟COPD组的LAA%-950与DLCO/VA存在负相关性(r=-0.62,P=0.00),与RV/TLC存在正相关性(r=0.59,P=0.00);P15-IN与DLCO/VA存在正相关性(r=0.53,P=0.01).结论 MSCT呼吸双相扫描能有效评价吸烟者肺气肿及空气潴留的改变,且LAA%-950及P15-IN指标能更敏感评价吸烟者肺功能改变.

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abstracts:

Objective To quantify emphysema and air trapping at inspiratory and expiratory phase multi-slice spiral CT(MSCT) scanning in smokers without respiratory symptoms,and analyze the correlation between the CT quantifiable parameters and lung function parameters.Methods A total of 72 smokers,who underwent medical examinations from September 2013 to September 2016 in Changzheng Hospital were enrolled in this research and were divided into two groups:24 smokers with COPD and 48 smokers without COPD.Besides,thirty-nine non-smokers with normal pulmonary function were enrolled as the controls.All subjects underwent double phase MSCT scanning and pulmonary function tests.CT quantifiable parameters of emphysema included the low attenuation area below a threshold of-950 Hounsfield Units (HU) (LAA%-950),the lowest 15th percentile of the histogram of end-inspiratory attenuation values (P15-IN),the lowest 15th percentile of the histogram of end-expiratory attenuation values (P15-EX),relative volume change (RVC) and the expiratory to inspiratory ratio of mean lung density (E/IMLD).Pulmonary function parameters included forced expiratory volume in 1 second expressed as percent predicted (FEV1%),forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC),residual volume to total lung capacity ratio (RV/TLC) and carbon monoxide diffusion capacity corrected for alveolar volume (DLCO/VA).The differences of CT quantifiable parameters and pulmonary function parameters among the three groups were analyzed by using one-way analysis of variance or Kruskal-Wallis H test.The correlation between CT quantifiable parameters and pulmonary function parameters was analyzed by using Spearman's correlation analysis.Results The differences of LAA%-950 (the values for the controls,the group of smokers with out COPDand the group of smokers with COPD were 0.5% ±0.7%,0.7% ± 1.2% and 2.0% ±2.4% respectively),P15-IN (the values of the three groups were (-892 ± 33),(-905 ± 15) and (-907 ±22) HU respectively),FEV1% (the values of the three groups were 88.4% ±8.8%,84.2% ±7.5% and 82.1% ± 8.0% respectively),FEV1/FVC (the values of the three groups were 78.0% ± 3.8 %,76.6% ±4.3 % and 67.3 % ± 5.5% respectively),DLCO/VA (the values of the three groups were (1.36 ± 0.25),(1.30 ±0.22) and (1.21 ±0.22) mmol · min-1 · kPa-1 · L-1 respectively) and RV/TLC (the values of the three groups were 49.5% ±6.6%,45.9% ±6.0% and 53.0% ±6.4% respectively) among the three groups were statistically significant (all P < 0.05).In the control group,LAA%-950 negatively correlated with FEV1/FVC and DLCO/VA (r =-0.32,P =0.04;r =-0.69,P =0.00) and neither did P15-IN with FEV1% (r =-0.14,P =0.02).Inversely,P15-IN positively correlated with DLCO/VA (r =0.55,P =0.00).In the group of smokers without COPD,LAA%-950 negatively correlated with FEV1/FVC and DLCO/VA(r =-0.31,P =0.04;r =-0.42,P =0.00),and P15-IN positively correlated with FEV1/FVC and DLCO/VA (r =0.33,P =0.02;r =0.30,P =0.04).In the group of smokers with COPD,LAA%-950 negatively correlated with DLCO/VA (r =-0.62,P =0.00),but positively correlated with RV/TLC (r =0.59,P =0.00).And P15-IN positively correlated with DLCO/VA (r =0.53,P =0.01).Conclusions Smokers emphysema and air trapping can be effectively evaluated by double phase MSCT.Moreover,two of the CT quantifiable parameters,LAA%-950 and P15-IN,are highly sensitive to changes in pulmonary function.

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作者: 张迪 [1] 管宇 [1] 范丽 [1] 夏艺 [1] 刘士远 [1]
期刊: 《中华医学杂志》2018年98卷19期 1467-1473页 MEDLINEISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.0376-2491.2018.19.003
发布时间: 2018-06-19
基金项目:
国家自然科学基金 上海市浦江人才计划(15PJD002)National Natural Science Foundation of China Shanghai Pujiang Talent Program
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