多层螺旋CT对早、中期慢性阻塞性肺疾病气道改变的检查及其病理基础

Study on the MSCT findings and the pathologic basis of airway changes in patients with COPD

目的:探讨早、中期慢性阻塞性肺疾病(COPD)患者气道改变的多层螺旋CT(MSCT)表现及其病理基础方法:研究组为因外周孤立性肺结节在我院行肺部手术切除的患者15例,其中非COPD患者5例;COPD患者中级3例,1级5例,2级2例。行全肺扫描,120kVp,50mA,螺矩为1.375∶1,X线管旋转速度为0.5s/周。在右肺上叶尖段支气管水平或下肺静脉水平加扫同层电影扫描,120kVp,35mA,扫描范围为10mm,患者平静呼吸,采集时间为9.1s,包括2～3个呼吸周期。由2位放射诊断医师评价病变所在肺叶肺段支气管壁,同时在肺窗下(窗宽1000HU窗位-500HU)以电影方式观察小气道和中心气道在呼吸周期中的开闭情况。手术标本行HE染色,且用Masson三色染色法对胶原纤维、肌纤维进行染色。结果:随着病情的进展逐渐出现气道壁的增厚和弹力下降改变,相应的病理改变是气道腺体的增生和平滑肌的断裂。结论:早期表现为腺体增生,1级时即可出现细支气管壁平滑肌的断裂,2级时出现支气管壁平滑肌的断裂及胶原纤维的增多。

Objective To discuss the multislice（MSCT） findings and pathologic basis of airway changes in patients with chronic obstructive pulmonary disease（COPD）. Methods Fifteen patients undergoing lung resection because of peripheral solitary nodules, including 5 non-COPD patients, 3 patients with stage 0 COPD, 5 with stage 1 COPD and 2 with stage 2 COPD, had total lung scan with 120 kVp, 280 mA, pitch 1.375：1 and rotation time 0.5 s/cycle. With the patient＇s informed consent, the cine scan with 120 kV, 35 mA, thickness 10 mm was taken at the level of the apical bronchus of fight upper lobe section （B1） or the inferior pulmonary vein section, which lasted 9.1 s including 2-3 respiratory cycles. The resected samples were treated with HE and Masson staining. Results With the disease aggravating, the airway wall became thick and the elastic force decreased. The corresponding pathological changes were hyperplasia of glands and rupture of smooth muscles in the airway. Conclusions In early COPD, the CT findings are based on hyperplasia of glands and rupture of smooth muscles at bronchus and bronchiole.