弥漫性间质性肺疾病的CT定量分析及与肺功能和视觉评估的相关研究

CT quantitative analysis of diffuse interstitial lung disease and correlation with physiologic tests and CT visual scores

目的:研究弥漫性间质性肺疾病(DILD)的CT定量参数与视觉评估(VS)、肺功能检查(PFT)指标的相关性,探讨CT定量分析对评估DILD肺功能损伤的价值。方法:DILD组(实验组)30例和健康对照组20例,各行深吸气屏气下CT薄层检查,并且实验组患者再行PFT。利用CT定量分析软件分析图像数据并得到相应肺功能参数:平均肺密度(MLA),两肺总容量(TLV),PI值(pixel indexes,像素指数,分为-1 024～-950,-950～-700,>-700区)。半定量的CT视觉评分包括病变严重性及病变范围。CT定量参数与PFT及VS间进行相关分析。结果:①不同肺弥散功能组间的CT定量参数间差异有统计学意义(P<0.05),除了轻中度组与重度组间PI-1 024～-950;实验组与对照组相比,TLV、PI-950～-700显著减小(P<0.05),而MLA、PI>-700显著增大(P<0.01)。②TLV与TLC呈正相关(r=0.619,P<0.01);PI>-700与VCMAX、FVC、DLCO呈负相关(r分别为-0.701、-0.739、-0.753,P<0.01);PI>-700与VS呈正相关(r=0.709,P<0.01);PI-950～-700与VCMAX、FVC、DLCO呈正相关。结论:CT定量指标是可用于评估DILD患者病变严重程度与随访的一种客观工具。

Objective： To study the correlation with quantitative indexes of computed tomography （CT）, spirometric pulmonary function tests （PFTs）, and visual scores （VSs） of CT in patients with diffuse interstitial lung disease （DILD） and to prove the estimated value of CT quantification for the prediction of pulmonary function impairment. Methods： DILD group （n=30） and normal control group （n=20） all underwent thin-section CT in the supine position at full inspiration, all patients of DILD also provided PFT. Quantitative indexes were obtained using a Sensation Pulmo Software. Quantitative indexes included total lung volume （TLV）, mean lung attenuation （MLA）, pixel indexes （-1024 --950, -950 --700, 〉 -700）. Visual scores measured semiquantitatively included the type and the extent of pulmonary parenchyma abnormality. Quantitative indexes were correlated with PFTs and VSs using the Pearson correlation test. Results： ①Quantitative indexes differed significantly between the DILD group and the control group, except for PI-1024--950 （P〈 0.05）.②TLV showed positive correlation with TLC （r=0.619, F〈 0.01）; PI〉-700 showed negative correlation with VCMAX. FVC and DLCO （r=0.701. -0.739. -0.753, respectively, P〈 0.01）; PI〉-700 showed positive corre-lation with VS （r=0.709, P〈 0.01）; PI-950--700 showed positive correlation with VCMAX. FVC and DLCO. Conclusion： Quantitative indexes can be used as an objective tool for quanti-tative evaluation of diseased extent and for follow-up of the progression or improvement of a DILD.