摘要目的 通过分析不同分级慢性阻塞性肺疾病(COPD)稳定期患者胸部定量CT的变化及其与肺功能和症状评分的相关性,探讨其能否做为评估COPD严重程度的方法之一.方法 研究对象为山西医科大学附属大医院呼吸科门诊的90例COPD患者,均行肺功能及胸部定量CT检查,症状评估采用MMRC问卷.根据2011年版GOLD综合评估的方法分为A、B、C和D四组.分别对各组肺功能、胸部定量CT肺气肿评估指标LAA％及症状评分进行相关性分析.结果 ①肺功能:FEV1％pred、VC、DL Adj、FEF75分别在A、B、C和D四组间差异有统计学意义(F分别为59.83,18.56,14.39,16.06,P值均＜0.05)；且C、D组均分别小于A和B组,差异均有统计学意义(P值均＜0.05)；A、B组间及C、D组间差异均无统计学意义(P值均＞0.05).RV,RV/TLC在A、B、C和D四组间差异无统计学意义(P值均＞0.05).②胸部定量CT:LAA％在CT阈值分别-1 024～-970、-960、-950、-940、-930、-920、-910 HU值下均为一致结果.在-i 024～-910 HU下,A、B、C和D四组间LAA％差异有统计学意义(F=20.22,P＜0.05),两两比较,C和D组LAA％分别大于A和B组,差异均有统计学意义(P值均＜0.05),B组大于A组,差异均有统计学意义(P＜0.05),C组与D组差异无统计学意义(P＞0.05).③相关性:(a)LAA％与肺功能各指标:在-1 024～-910 HU下LAA％与FEV1％ pred、FEF75、DL Adj均呈显著负相关,(r分别为-0.686,-0.509,-0.481,均P＜0.01)；与RV和RV/TLC无相关性(P=0.34).(b)LAA％与症状评分:在-1 024～-910 HU下LAA％与MMRC呈显著正相关,(r=0.570,P＜0.01).(c)症状评分与肺功能各项指标:MMRC与FEV1％ pred、FEF75及DL Adj呈显著负相关(r分别为-0.493,-0.330,-0.267,前两者P值均＜0.01,后者P＜0.05).结论 肺气肿可能为A、B两组患者临床症状出现差异的原因之一.COPD患者气流受限严重程度、小气道功能和弥散功能的改变及症状评分与胸部定量CT肺气肿严重程度相关.对于GOLD肺功能分级轻中度以下(FEV1％pred≥50％)的COPD患者,胸部定量CT LAA％评估肺气肿严重程度优于肺功能.胸部定量CT可以做为评估COPD严重程度的方法之一.

abstractsObjective Through the analysis of the patients's Chest quantitative CT changes that with different classification of chronic obstructive pulmonary disease (COPD) and pulmonary function and the correlation of symptom scores,and discussed it can be or not as a way of assessment of the severity of COPD.Methods The research object were our respiratory medicine outpatient service of 90 cases of patients with COPD,each patient did pulmonary function and chest quantitative CT examination,the symptom assessment using MMRC questionnaire.According to the 2011 GOLD guide joint assessment method is divided into A,B,C and D groups.Each group respectively on pulmonary function,chest CT pulmonary emphysema quantitative evaluation index LAA ％ and symptom scores for correlation analysis.Results ① Pulmonary function.-The four FEV1 ％ pred,VC,DL Adj,FEF75 were statistically significant difference respectively in A,B,C and D four groups.(F =59.83,18.56,14.39,16.06,allP ＜0.05),and C,D group respectively are less than A and B group,the differences were statistically significant (P ＜0.05),A and B,C and D between-group differences were no statistical significance (P ＞0.05).RV,RV/TLC in A,B,C and D four groups difference was not statistically significant (P ＞0.05).②Chest quantitative CT:LAA％ In CT threshold respectively-1 024 ～-970,～-960,～-950,～-940,～-930,～-920,～-910 HU values are consistent results,in-1 024～-9 10 HU,LAA ％ in A,B,C and D four groups's difference have statistical significance (F =20.22,P ＜0.05),pairwise comparation,LAA％ in C and D group were greater than A and B group,the differences were statistically significant (P ＜ 0.05).Group B more than in group A,the differences were statistically significant (P ＜ 0.05).C and D group difference was not statistically significant (P ＞0.05).③ Correlation..(a)LAA％ and pulmonary function each index LAA％ (in-1 024～-910 HU),with FEV:％ pred,FEF75,DL Adj all has significant negative correlation,(r =-0.686,-0.509,-0.481,all P ＜0.01),And with RV and RV/TLC have no correlation (P =0.34).(b)LAA ％ and symptom scores LAA％ (in-1 024～-910 HU) and MMRC is a significant positive correlation,(r =0.570,P ＜0.01).(c)Symptom scores and pulmonary function each index MMRC and FEV1 ％pred,FEF75 and DL Adj has significant negative correlation (r =0.493,0.330,0.267,and the two before P ＜0.01,the latter P ＜0.05).Conclusions Emphysema may be a reason for the differences of A,B two groups of patients with clinical symptoms.Patients with COPD airflow restricted severity,small airway function and dispersion function changes and the symptom score are which with chest quantitative CT pulmonary emphysema severity are correlation.GOLD for lung function classification under mildmoderate patients with COPD (FEV1％ pred ≥ 50％),chest quantitative CT LAA％ evaluation emphysema is better than that of severity of pulmonary function.Chest quantitative CT ia one way of a assessment of the severity of COPD.