COPD患者PA管径与肺功能及CT肺容积参数的相关性分析

Correlation Analysis between the Diameter of Pulmonary Artery and Pulmonary Function,CT Volume Parameters in COPD Patients

目的分析1~4级肺动脉(PA)管径与肺功能及CT肺容积参数的相关性。方法通过曲面重组方法测量48例慢性阻塞性肺疾病(COPD)患者肺动脉干(A1)、左/右肺动脉(LA2/RA2)、右肺上叶肺动脉(RUA3)、左/右肺下叶肺动脉(LLA3/RLA3)、右肺上叶尖段肺动脉(RUA4)、左肺上叶前段肺动脉(LUA4)、右肺中叶外段肺动脉(RMA4)、左/右肺下叶背段肺动脉(LLA4/RLA4)的管径,评价其与肺功能指标FEV1、FEV1%、FVC、FEV1/FVC、MEF25、MEF25%及CT肺容积参数[全肺容积(TLV)、肺气肿容积(TEV)、肺气肿指数(EI)]的关系。结果第1级PA管径慢性阻塞性肺疾病全球倡议(GOLD)仅Ⅰ与Ⅱ级、Ⅱ与Ⅲ级存在差异(P=0.009,P=0.002)。第2级PA管径GOLDⅠ与Ⅱ级、Ⅱ与Ⅲ级、Ⅱ与Ⅳ级存在差异(P=0.003;P=0.034,P=0.043;P=0.041)。第3级PA管径GOLDⅠ与Ⅲ、Ⅰ与Ⅳ级存在差异(P=0.004,P=0.024;P=0.009,P=0.003)。第4级PA管径GOLDⅠ与Ⅱ、Ⅰ与Ⅲ、Ⅰ与Ⅳ、Ⅱ与Ⅳ及Ⅲ与Ⅳ级存在差异(P=0.015;P=0.019,P=0.000;P=0.000,P=0.000,P=0.015;P=0.006,P=0.006,P=0.006,P=0.018;P=0.027)。第1~2级PA管径与肺功能指标无相关性。第3级PA管径与肺功能指标呈弱负相关性(r=-0.289^-0.486)。第4级PA管径与肺功能指标呈中等正相关性(r=0.378~0.716)。第1~2级PA管径与CT肺容积参数无相关性,第3级部分PA管径与CT肺容积参数呈中等正相关性(r=0.415~0.551),第4级PA除RUA4、LUA4外,其余4级PA管径均与所有CT肺容积参数呈弱至中等负相关性(r=-0.366^-0.717)。结论随着COPD患者PA管径的变细,不同GOLD级别间的差异也越显著。第3级PA管径随着肺功能指标的减小和CT肺容积参数的增高而增宽,而第4级PA管径则变窄。第4级PA管径与肺功能指标及EI的相关性较第3级PA大。FEV1%、FEV1/FVC及TEV、EI与第3~4级PA的相关性较高。

Objective To evaluate the con＇elation between the diameter of level-1 to level-4 pulmonary artery （PA） and the puhnonary function, CT pulmonary volumetric parameters in patients with chronic obstructive puhnonary disease （COPD）. Methods By using nmlti-planar reconstruction technique, the measurements of the diameters of the pulmona- ry stem （AI） , left/right pulmonary artery （LA2/RA2） , right upper lobe pulmonary artery （RUA3）, left/right lower lobe pulmonary artery （ LLA3/RLA3 ）, the apical segment artery of right upper lobe （ RUA4）, the anterior segment artery of left upper lobe （LUA4） , the lateral segment artery of right middle lobe （RMA4） , and left/right dorsal segment artery of lower lobe （LLA4/RLA4） were performed in 48 COPD patients. The correlation between the diameters of these arteries and the pulmonary function indexes （including FEVI, FEV1%, FVC, FEVI/FVC, MEF25 and MEF25% ） as well as with CT pulmonary volumetric parameters （including TLV, TEV and EI） were evaluated. Results Statistically signifieaut diflbr- ence in level-I PA diameter existed between GOLD Ⅰ and Ⅱas well as betweenⅡand Ⅲ （ P = 0. 009 and P = 0. 002 re- spectively） ; statistically significant difference in level-2 PA diameter existed between GOLD I and Ⅱ , II and Ⅲ, as well as between Ⅱ and 1V （P =0. 003, P =0. 034 ; P =0. 043, P =0. 041 respectively） ; statistically significant difference in level-3 PA diameter existed between GOLD I and llI and between I and IV （ P = 0. 004, P = 0. 024 ; P = 0. 009, P = 0. 003 respectively） ; and statistically significant difference in level-4 PA diameter existed between GOLD I and Ⅱ , Ⅰand HI, Ⅰ and IV, Ⅱ and IV, m and IV （P=0.015, P=0.019; P=0.000, P=0.000; P=0.000, P=0.015;P=0. 006; P =0. 006, P =0. 006; P =0. 018, P =0.027 respectively）. No obvious correlation existed between level-1, level-2 PA diameter and pulmonary function indexes. Level-3 PA diameter showed weak negative correlation with pulmonary func- tion indexes （ r = - 0. 289 to r = - 0. 486）, and a moderate positive correlation existed between level-4 PA diameter and pulmonary function indexes （r = 0. 378 to r = 0.716）. No obvious correlation existed between level-1, level-2 PA diameter and CT pulmonary volume parameters （r = 0. 415 to r = 0. 551 ） , while a moderate positive correlation existed between lev- el-3 PA diameter and CT pulmonary volume parameters （r = 0. 415 to r = 0.551 ）. Level-4 PA diameter, except RUA4 and LUA4, bore a weak to moderate negative correlation with CT pulmonary volume parameters （ r = - 0. 366 to r = - 0. 717）. Conclusion With the thinning of PA diameter in COPD patients, the differences in GOLD become more significant. The level-3 PA becomes widened with the decreasing of pulmonary function and the increasing of CT volumetric parameters, while the level-4 PA diameter becomes narrowed. The correlation between the level-4 PA diameter and pulmonary function as well as El is greater than that between level-3 PA diameter and pulmonary function. The correlations between the level- 3 and level-4 PA diameter and FEV1% , FEV1/FVC and TEV, EI are more obvious.