HRCT征象与肺功能检查指标在IPF中的相关性研究

Correlation between pulmonary function tests and HRCT signs in the evaluation of idiopathic pul-monary fibrosis

目的 探讨在HRCT各种征象与肺功能检查的指标之间可能存在的相关性。方法 33例临床上怀疑IPF的病人(女性18例,男性15例,年龄范围16-73岁,平均56岁),在连续的时间内接受了HRCT扫描和肺功能检查。对HRCT的图象根据玻璃影、网织、蜂窝、肺气肿、支气管扩张和淋巴结的累及范围进行了评分统计,然后与肺功能能测定的各项指标和功能不全的分级进行Spearman相关性分析和多元回归相关分析。结果 磨玻璃影的范围与动态肺活量的指标FEVI/FVC之间存在负相关,与PEF、MMF之间存在显著负相关(P<0.01),而且与肺功能不全的分级间亦存在相关性。与之不同的是,网织影、蜂窝、支扩的累及范围均与气体弥散指标,尤其是DLco/Va之间存在负相关性(P<0.05),经多元回归分析发现蜂窝的出现对弥散功能影响最大。结论 通过对HRCT征象的分析有助于对肺的功能进行预测,根据磨玻璃影的消长可以估测肺功能不全的轻重,蜂窝的出现则最能表现明弥散功能正在减低。

Purpose To determine which indices of lung function best correspond to the extent of disease on HRCT, and which radiographic singns on HRCT influence the function. Methods 33 patients with suspected IFF (female 18, male 15, age range 16 - 73, mean age 56)underwent HRCT and PFT consecutively. A scoring system was adopted to evaluate the involved extent of HRCT findings according to the following signs: ground glass opacity (GGO) , reticular structures,honeycombing, emphysema, bronchiolectasis, and mediastinal lymph nodes. Statistical relationships between scores of singns and PFT s indices were determined by Spearsman correlation analysis and multiple regression analysis. Results The analytic results showed GGO negativedly correlated with FEV1/FVC(P<0.05) ,PEF(p< 0.01) ,MMF(p < 0.01) , and the staging of pulmonary dysfunction(p < 0. 05). In contrast, correlation between the extent of reticular pattern, honeycombing, emphysema and diffuse capacity, especially the percent predicted DLco/Va was shown, and on multiple regression analysis honeycombing played a major role. Conclusion Evaluation of HRCT signs conduces to predict the lung function, the change of GGO corresponds to the pulmonary dysfundtion, and the emergence of honeycombing implicates deteriorating diffuse capacity.