稳定期慢性阻塞性肺疾病患者胸部定量CT测量指标与呼吸道症状的关联研究

Correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with chronic obstructive pulmonary disease in stable stage

目的评估稳定期慢性阻塞性肺疾病(慢阻肺)患者胸部定量CT测量指标与呼吸道症状之间的关联。方法前瞻性纳入2021年3月至2022年2月就诊于北京医院门诊的稳定期慢阻肺患者186例,收集患者人口学资料、呼吸道症状及肺功能,使用FACT医学影像信息系统处理高分辨CT(HRCT)原始DICOM数据,并自动测量肺气肿指标像素指数-950(PI-950)与代表段及亚段支气管的4~6代支气管管壁厚度(4~6 T)、管壁面积百分比(4~6WA%)。根据改良英国医学研究委员会呼吸困难量表(mMRC)评分(0~1分为低分组,2~4分为高分组)、慢阻肺评估测试评分(CAT)(分数<10分为低分组,≥10分为高分组)、咳嗽、咳痰与喘鸣(无症状组与症状组)分别进行二分组作为因变量,采用logistic回归模型评估影像学参数与以上症状的关系。结果186例患者中,男162例,女24例;年龄(68.9±9.3)岁;mMRC高分组83例,CAT高分组120例,咳嗽组146例,咳痰组154例,喘鸣组65例。mMRC高分组年龄及肺气肿参数PI-950均高于低分组,而用药后第一秒用力呼气容积(FEV_(1))占预计值百分比(FEV_(1)%预计值)、一氧化碳弥散量(DLCO)占预计值百分比(DLCO%预计值)及用药后最大中期呼气流速(MMEF)占预计值百分比(MMEF%预计值)低于低分组(均P<0.05)。CAT高分组年龄高于低分组,而用药后FEV_(1)%预计值及用药后MMEF%预计值低于低分组(均P<0.05)。咳嗽组男性比例、有吸烟史比例及吸烟指数均高于无咳嗽组,而4WA%低于无咳嗽组(均P<0.05)。咳痰组男性比例、有吸烟史比例、吸烟指数及PI-950高于无咳痰组,而用药后FEV_(1)%预计值、4WA%低于无咳痰组(均P<0.05)。喘鸣组5WA%及6WA%高于无喘鸣组,而用药后MMEF%预计值低于无喘鸣组(均P<0.05)。多因素logistic回归模型分析显示,调整了人口学特征、吸烟、合并疾病及肺功能混杂因素后,PI-950每增加10%,mMRC高分组风险增加67.3%(OR=1.673,95%CI:1.052~2.658);6 WA%每增加10%,出现喘鸣的风险增加3.189倍(OR=4.189,95%CI:1.070~16.395)。未发现各影像学指标与咳嗽、咳痰、CAT评分的关联(均P>0.05)。结论稳定期慢阻肺患者定量CT测量可解释呼吸道症状的存在及严重程度,肺气肿指标与呼吸困难相关,近端气道的管壁面积百分比与喘鸣相关。

Objective To explore the correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with stable chronic obstructive pulmonary disease(COPD).Methods A total of 186 patients with COPD in stable stage who visited in the outpatient department of Beijing Hospital from March 2021 to February 2022 were prospectively included.Demographic data,respiratory symptoms and lung function were collected.The original DICOM data of high-resolution CT(HRCT)were processed using the FACT medical imaging information system and the pulmonary emphysema index pixel index-950(PI-950)and the airway wall thickness(4-6 T)and the percentage of airway area(4-6 WA%)of the 4-6 generation bronchi which represent the segmental and subsegmental bronchi were measured automatically.According to the modified British medical research council dyspnea scale(mMRC,0-1 point for low score group,2-4 points for high score group),chronic obstructive pulmonary disease assessment test(CAT,score<10 points for low score group,≥10 points for high score group),cough,expectoration and wheezing(asymptomatic group and symptomatic group),they were divided into two groups as dependent variables.The relationship between imaging parameters and the above symptoms was evaluated using a logistic regression model.Results The study ultimately included 186 patients who met the inclusion criteria,including 162 males and 24 females,aged(68.9±9.3)years old.There were 83 patients in the high mMRC group,120 patients in the high CAT group,146 patients in the cough group,154 patients in the expectoration group,and 65 patients in the wheezing group.The age and emphysema parameter PI-950 in the high score group of mMRC were higher than those in the low score group,while the percentage of the forced expiratory volume in 1 second(FEV_(1))predicted value(FEV_(1)pred)after medication,the percentage of carbon monoxide diffusion volume(DLCO)predicted value(DLCO pred),and the percentage of the maximum midexpiratory flow(MMEF)predicted value(MMEF pred)after medication were lower than those in the low score group(all P<0.05).The age of the high CAT group was higher than that of the low score group,while FEV1 pred and MMEF pred after medication were lower than those of the low score group(all P<0.05).The proportion of males,patients with smoking history,and smoking index in the cough group were higher than those in the non cough group,while the 4 WA%was lower than that in the non cough group(all P<0.05).The proportion of males,patients with smoking history,smoking index,and PI-950 in the expectoration group were higher than those in the non expectoration group,while FEV1 pred after medication and 4 WA%were lower than those in the non expectoration group(all P<0.05).The 5 WA%and 6 WA%of the wheezing group were higher than those of the non wheezing group,while MMEF pred after medication was lower than that of the non wheezing group(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for demographic characteristics,smoking,combined diseases,lung function and other confounding factors,for every 10%increase in PI-950,the likelihood of developing more severe dyspnea for the patients(high score group according to mMRC)increased by 67.3%(OR=1.673,95%CI:1.052-2.658);Every 10%increase in 6WA%increased the likelihood of wheezing by 3.189 times(OR=4.189,95%CI:1.070-16.395).No correlation was found between various imaging indicators and cough,expectoration,and CAT scores(P>0.05).Conclusion Quantitative CT measurement indicators in stable COPD patients can explain the presence and severity of respiratory symptoms,the pulmonary emphysema indicator is associated with dyspnea,and the percentage of proximal airway wall area is associated with wheezing.