多层螺旋CT对慢阻肺及哮喘-慢阻肺重叠综合征的定量研究

The Quantitative Study of Multi-layer Spiral CT on COPD and Asthma-COPD Overlap Syndrome

目的:探讨慢性阻塞性肺疾病(COPD)与哮喘-慢阻肺重叠综合征(ACOS)气道重构的差异。方法:COPD患者45例,平均年龄(65.6±7.9)岁,ACOS患者40例,平均年龄(68.0±6.7)岁,分别行螺旋CT及肺功能检查,测量右肺上叶尖段气道横截面总面积At和管腔横截面积Al,计算管壁面积WA、管壁面积占气道总面积的百分比(WA%)及管壁厚度(WT),比较COPD与ACOS气道指标、肺功能差异,分析气管舒张药反应性(BDR)与气道指标(WA%、WT)及肺功能(FEV1%、FEV1/FVC)的相关性。结果:ACOS组WT(1.72±0.66)mm,大于COPD组的(1.69±0.69)mm(P<0.05)。ACOS组WA%为(78.88±5.01)大于COPD组的(76.46±4.72)(P <0.05)。ACOS组与COPD组肺功能差异无统计学意义(P>0.05)。BDR与WT、WA%正相关(r=0.365、0.407,P<0.05),与FEV1%、FEV1/FVC及年龄无关(r=-0.167、0.148、0.133,P>0.05)。结论:ACOS与COPD患者气道重构模式不同,不同的重构模式反映ACOS和COPD病理进程的差异。

Objective: To evaluate the difference of airwaywall remodeling between COPD and ACOS. Methods: 45 COPD patients which averge age is(65.6±7.9) and 40 ACOS patients which averge age is(68.0±6.7) performed with MSCT and PFT. The areas of apical segmental bronchi of the right upper lobe were measured, including indicators such as total airway cross sectional area(At), airway luminal area(Al) and calculate airway wall area(WA), the percentage of airway wall area to total airway cross sectional area(WA%) and airway wall thickness(WT). The differences of those indicators and PFT in COPD and ACOS subjects were compared. The correlation between bronchodilator responsiveness(BDR) and airway indicators(WA%,WT), and PFTC(FEV1%, FEV1/FVC) were analyzed. Results: The WT of ACOS group is(1.72±0.66) mm and higher than that in COPD group at(1.69±0.69) mm(P<0.05). The WA% of ACOS group is(78.88±5.01), and higher than that in COPD group at(76.46±4.72)(P<0.05). PFT had no difference between ACOS group and COPD group(P >0.05). BDR was related to WT and WA%(r = 0.365、0.407,P <0.05). The correation had no significance between BDR and FEV1, FEV1/FVC and age(r =-0.167, 0.148, 0.133, P >0.05). Conlution: The remodeling of airway in ACOS and COPD subjects is heterogeneous and the different pattern of remodeling reflect differences in the pathological processes in ACOS and COPD.