慢性阻塞性肺疾病患者胸大肌CT参数与肺功能及疾病严重程度的关系

Relationship between pectoralis major muscle CT parameters and lung function and disease severity in patients with chronic obstructive pulmonary disease

目的基于广义线性模型分析计算机断层扫描(CT)的胸大肌面积(PMA)和胸大肌密度(PMD)与慢性阻塞性肺疾病(COPD)患者肺功能及疾病严重程度的关系。方法回顾性收集2021-01至2023-12联勤保障部队第910医院收治的COPD患者临床资料293例,根据胸部CT主动脉弓上方轴位图像测量PMA和PMD。使用广义线性模型分析PMA和PMD与肺功能、疾病严重程度参数的相关性。结果与高PMA相比,低PMA组的FVC、FVC占预计值%、FEV_(1)、FEV_(1)占预计值%、FEV_(1)/FVC均降低(P均<0.05),而CAT评分、肺气肿指数更高(P<0.05)。PMA每增加10 cm^(2),FVC增加0.17 L、FVC占预计值%增加4.47%,FEV_(1)增加0.21 L、FEV_(1)占预计值%增加8.02%,FEV_(1)/FVC增加0.04,肺气肿指数降低2.58。与高PMD组相比,低PMD组的FVC占预计值%、FEV_(1)占预计值%、FEV_(1)/FVC均降低(P均<0.05),而肺气肿指数冲高(P=0.007)。PMD每增加10 HU,则FVC占预计值%增加4.64%,FEV_(1)增加0.14 L,FEV_(1)估计值增加8.56%,FEV_(1)/FVC增加0.04(P<0.05)。结论CT测量的PMA和PMD与COPD患者的疾病严重程度和肺功能具有相关性,可作为评估患者疾病严重程度的参数。

Objective To analyze the relationship between pectoral major muscle area(PMA)and pectoral major muscle density(PMD)measured by computed tomography(CT)and lung function and disease severity in patients with chronic obstructive pulmonary disease(COPD)based on generalized linear model.Methods Clinical data of 293 COPD patients admitted to the 910th Hospital of PLA Joint Logistics Support Force from January 2021 to December 2023 were retrospectively collected.PMA and PMD were measured based on axial images above the aortic arch on chest CT.Generalized linear models were used to analyze the correlation between PMA and PMD and parameters of lung function and disease severity.Results Compared with the high PMA group,the low PMA group had lower forced vital capacity(FVC),FVC as a percentage of the predicted value,forced expiratory volume in one second(FEV_(1)),FEV_(1)as a percentage of the predicted value,and FEV_(1)/FVC ratio(P<0.05),but higher CAT scores and emphysema index(P<0.05).For every 10 cm^(2)increase in PMA,there was a 0.17L increase in FVC,a 4.47%increase in FVC as a percentage of the predicted value,a 0.21 L increase in FEV_(1),an 8.02%increase in FEV_(1)as a percentage of the predicted value,a 0.04 increase in FEV_(1)/FVC ratio,and a 2.58%decrease in emphysema index.Compared with the high PMD group,the low PMD group had lower FVC as a percentage of the predicted value,FEV_(1)as a percentage of the predicted value,and FEV_(1)/FVC ratio(P<0.05),but a higher emphysema index(P=0.007).For every 10 HU increase in PMD,there was a 4.64%increase in FVC as a percentage of the predicted value,a 0.14 L increase in FEV_(1),an 8.56%increase in FEV_(1)as a percentage of the estimated value,and a 0.04 increase in FEV_(1)/FVC ratio(P<0.05).Conclusions PMA and PMD measured by CT are correlated with disease severity and lung function in COPD patients,and can be used as parameters to evaluate disease severity in patients.