CT灌注成像和肺功能检查对早期硅沉着病的比较观察

Comparative Observation of Early Stage of Silicosis by CT Perfusion Imaging and Pulmonary Function Test

目的探讨高分辨率CT（HRCT）及灌注成像对早期硅沉着病的诊断价值。方法选择在2009年10月～2012年12月期间确诊为早期硅沉着病病患者32例作为观察组，同时选择同期健康人20名作为对照组，两组都进行肺部HRCT灌注成像并借助软件行定量分析，包括测量表面通透性（PS）、血流量（BY）、平均通过时间（MTT）和血容量（BV），同时进行肺功能检查，包括第1秒最大呼气量（FEV1）、用力肺活量（FVC）、及两者的百分比（FEV1／FVC％）和肺总量（TLC），并进行相关性分析。结果早期硅沉着病HRCT主要表现为弥漫分布的小结节、细条索状、纵隔肺门区淋巴结钙化。观察组BF、BV、PS、FEV1、FVC均较对照组间减小，两者比较具有统计学差异（P〈0．05），MTT比较无统计学差异（P〉0．05），BF、BV、PS与FEV1／FVC％均呈中度正相关，相关系数分别为0．51、0．67与0．49。结论早期硅沉着病对肺功能的损害是明显的，HRCT灌注成像并定量分析能反映肺功能损害程度，使早期硅沉着病诊断与疗效评价更加准确、客观。

Objective To explore the diagnostic value of high resolution CT （HRCT） and CT perfusion imaging in early stage of sil- icosis. Methods From Oct. 2009 to Dec. 2012, 32 patients with early stage of silicosis （silicosis group） and 20 healthy adults （control group） were enrolled in the present study. All patients underwent pulmonary HRCT and CT perfusion imaging studies. Hemodynamic pa- rameters including capillary vessel permeability surface （PS） , blood flow （BF） , mean transmit time （MTT） , and blood volume （BV） were calculated by software on CT perfusion imaging. Pulmonary function parameters containing forced expiratory volume in 1 second （FEV1）, forced vital capacity （FVC）, FEV1/FVC% , and total lung capacity （TLC） were acquired by pulmonary function test. The correlation between hemodynamic parameters and pulmonary function parameters was analyzed. Results On HRCT, early stage of silicosis presented diffuse distributed small nodules and thin cordlike hyperdensity in the lung and lymph node calcification in the mediastinum. BF, BV, PS, FEV1 and FVC were significantly decreased in the silicosis group when compared with control group. However, MTT was found no significant difference between the two groups. BF, BV and PS were moderately correlated with FEV1/FVC% , and the correlation coefficient was 0.51 , 0.67 and 0.49 respectively. Conclusion Early stage of silicosis has obvious harm effect on pulmonary function. HRCT perfusiou imaging and its quantitative analysis were useful in assessment of the degree of pulmonary function injury, and which will make the diagnosis and therapeutic evaluation of early stage of silicosis more accurate and objective.