CT定量技术在慢性阻塞性肺疾病不同临床表型患者中的应用价值

Application Value of CT Quantitative Technique in Patients with Different Clinical Phenotypes of Chronic Obstructive Pulmonary Disease

目的探讨CT定量技术在慢性阻塞性肺疾病(COPD)不同临床表型患者中的应用价值。方法搜集处于稳定期的COPD患者,包括支气管炎型128例、肺气肿型120例,所有患者行胸部CT检查和肺功能检查。利用"数字肺"CT定量软件测量两型COPD患者的肺体积、肺血管体积、-950 HU低密度衰减区占两肺体积百分比(%LAA-950)和平均肺密度,比较两型COPD患者的肺功能和CT定量指标的差异,并进行相关性分析。结果肺气肿型COPD患者慢性阻塞性肺疾病全球倡议(GOLD)Ⅰ~Ⅳ级的第1秒用力呼气容积实测值与预测值百分比(FEV1%pred)分别为85.08±4.03、59.95±6.09、38.71±6.61、25.25±4.14(P<0.01);第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)分别为68.67±6.93、60.72±5.99、51.27±8.31、43.28±9.23(P<0.01);%LAA-950分别为31.38±14.22、32.05±13.56、41.19±13.00、42.17±13.57(P<0.01);两肺血管体积分别为(129.62±15.37)ml、(125.98±16.08)ml、(121.40±15.31)ml、(119.86±16.52)ml(P=0.04);两肺平均密度分别为(-821.69±45.68)HU、(-825.10±43.34)HU、(-849.01±42.90)HU、(-861.09±44.87)HU(P=0.01);支气管炎型FEV1%pred分别为89.71±9.46、59.87±9.16、39.08±6.29、23.58±4.60(P<0.01);FEV1/FVC分别为65.42±9.29、59.63±6.78、49.63±6.37、41.54±5.28(P<0.01);%LAA-950分别为11.72±7.85、14.38±8.24、19.96±8.01、26.56±10.23(P<0.01);两肺平均密度分别为(-816.52±42.51)HU、(-828.29±38.90)HU、(-839.00±42.90)HU、(-842.11±37.19)HU(P<0.01);两型患者FEV1%pred、FEV1/FVC、平均肺密度及肺气肿型患者的肺血管体积随着GOLD分级升高而下降,%LAA-950则随着GOLD分级升高而增加。两型GOLD各级患者的%LAA-950仅与FEV1/FVC紧密相关,肺气肿型Ⅰ~Ⅳ级r分别为-0.458、-0.362、-0.683、-0.496(P<0.05)、支气管炎型r分别为-0.634、-0.510、-0.577、-0.329(P<0.05)。结论CT定量分析可有效反映不同临床表型COPD患者在肺气肿严重程度、肺小血管定量指标变化的异质性特点。

Objective To explore the value of CT quantitative technique in patients with different clinical phenotypes of COPD.Methods Retrospective collection of patients with stable COPD,including 128 cases of bronchitis-type and 120 cases of emphysema-type,and all patients underwent chest CT examination and pulmonary function tests.According to the GOLD grading standard of the《2018 Global Strategy for the Diagnosis,Treatment and Prevention of Chronic Pulmonary Diseases》,all patients were classified into 4 levels.The"digital lung"CT quantitative software was used to analyze and measure the volume of lungs,pulmonary vascular volume,the proportion of pulmonary vessels,%LAA-950 and the average lung density in the two phenotypic COPD patients.Comparison of the differences in lung function and CT quantitative indicators between the two phenotypic COPD patients was done,and the correlation analysis was carried out.Results The FEV1%pred of GOLD I^IV grade in patients with emphysema-type COPD were:85.08±4.03,59.95±6.09,38.71±6.61,25.25±4.14(P<0.01);FEV1/FVC were:68.67±6.93,60.72±5.99,51.27±8.31,43.28±9.23(P<0.01);%LAA-950 were:31.38±14.22,32.05±13.56,41.19±13.00,42.17±13.57(P<0.01);the volume of the two pulmonary vessels were:129.62±15.37,125.98±16.08,121.40±15.31,119.86±16.52(P=0.04);the average density of the two lungs were:-821.69±45.68,-825.10±43.34,-849.01±42.90,-861.09±44.87(P=0.01);The FEV1%pred of GOLD I^IV grade in patients with bronchitis-type COPD were:89.71±9.46,59.87±9.16,39.08±6.29,23.58±4.60(P<0.01);FEV1/FVC were:65.42±9.29,59.63±6.78,49.63±6.3741.54±5.28(P<0.01);%LAA-950 were:11.72±7.85,14.38±8.24,19.96±8.01,26.56±10.23(P<0.01);the average density of the two lungs was:-816.52±42.51,-828.29±38.90,-839.00±42.90,-842.11±37.19(P<0.01).The FEV1%pred,FEV1/FVC and mean lung density of both types,and the pulmonary vascular volume of emphysema-type decreased with increasing GOLD grade,and%LAA-950 increased with increasing GOLD grade.%LAA-950 of patients with two types of GOLD was only closely related to FEV1/FVC,emphysema type(Ⅰ-Ⅳgrade r was-0.458,-0.362,-0.683,-0.496,P<0.05),and bronchitis Type(r is-0.634,-0.510,-0.577,-0.329,P<0.05).Conclusion CT quantitative analysis can effectively reflect the heterogeneity of the severity of emphysema and the changes of pulmonary vascular quantitative indexes in patients with different clinical phenotypes of COPD.