慢性阻塞性肺疾病患者及健康志愿者气管指数与肺功能的相关性研究

A study of the correlation between tracheal index and pulmonary function in patients with chronic obstructive pulmonary disease and healthy volunteers

目的：分析慢性阻塞性肺疾病（COPD）患者及正常志愿者的上气道CT定量参数的差异,探讨COPD患者及健康志愿者气管指数（TI）与肺功能参数的相关性。方法：对54例COPD患者和57例健康志愿者进行肺功能检查和胸部CT检查。按照COPD GOLD分期将COPD患者分为Ⅰ~Ⅳ级,根据COPD高危因素（吸烟〉10包年）将健康志愿者分为吸烟组和非吸烟组,测量主动脉弓上缘1cm气管和左、右主支气管开口处的前后径（APD）和横径（TRD）,并计算TI（TI=TRD/APD）。分析COPD患者和健康志愿者的气道CT定量参数的差异,同时评估TI与肺功能的相关性。结果：COPD组和对照组间年龄、身高、体重及BMI差异无统计学意义（P〉0.05）。COPD组和对照组在左、右主支气管开口处TI差异有统计学意义（P=0.001、0.002）,在主动脉弓上缘1cm水平TI差异无统计学意义（P=0.134）。COPD组和对照组的右主支气管TI分别与FEV1（r=0.345,P=0.000）,与FVC（r=0.277,P=0.002）,与FEV1/FVC（r=0.339,P=0.000）有一定的相关性。左主支气管TI与FEV1（r=0.233,P=0.008）、FVC（r=0.184,P=0.039）、FEV1/FVC（r=0.218,P=0.014）有一定的相关性。而主动脉弓上缘1cm水平TI与FEV1、FVC、FEV1/FVC均无明显统计学差异（P〉0.05）。COPD各级主支气管TI、左主支气管TI、右主支气管TI差异均无明显统计学意义（P〉0.05）;对照组内吸烟组和非吸烟组主支气管TI,左、右主支气管TI差异均无统计学意义（P〉0.05）。结论：COPD组左、右主支气管TI值均低于对照组（P〈0.05）,且COPD左、右主支气管的TI值与肺功能参数（FEV1、FVC、FEV1/FVC）具有一定的相关性,因此TI可作为评价COPD肺功能的量化指标。

Objective：The aims of this study were to analyze the differences of CT quantitative parameters in upper airway in all COPD patients and healthy volunteers,and to quantitatively evaluate the correlation between tracheal index and pulmonary function.Methods：54COPD patients and 57 healthy volunteers were undertaken both pulmonary function test and chest CT scan.The COPD patients were classified asⅠ~Ⅳ grades according to GOLD staging system;the healthy volunteers were divided into smoking group and non-smoking group according to COPD high risk factors（cigarette smoking10pack years）.The antero-posterior diameter（APD）and transverse diameter（TRD）of the trachea at 1cm above the aortic arch and the openings of left and right main bronchi were measured,and the tracheal index（TI）was further calculated（TI=TRD/APD）.The differences of CT quantitative parameters between COPD patients and healthy volunteers were analyzed.The correlation between TI and lung function were also evaluated.Results：There was no significant difference in age,height,weight and BMI between COPD group and control group（P0.05）.There was a significant TI difference at the openings of left and right main bronchi（P=0.001,P=0.002）,and there was no significant difference in TI 1cm above the aortic arch（P=0.134）between COPD group and the control group.There was direct relationship between TI and FEV1（left main bronchus：R=0.345,P=0.000,right main bronchus：R=0.233,P=0.008）,FVC（left main bronchus：R=0.277,P=0.002）,right main bronchus：R=0.184,P=0.039）,FEV1/FVC（left main bronchus：R=0.339,P=0.000,right main bronchus：R=0.218,P=0.014,respectively.But there was no significant difference between TI and FEV1,FVC,FEV1/FVC（P0.05）.There was no significant correlation in main bronchus TI,left main bronchus TI,right main bronchus TI of various levels of COPD and control group（P005）.Conclusions：The TIs of the left and right main bronchus in COPD group were smaller than that in control group（P0.05）.And there was a significant difference between two groups.The left and right main bronchus TI had significant correlation with pulmonary function parameters（FEV1,FVC,FEV1/FVC）,which could be an indicator of the evaluation of pulmonary function.