50岁以上无临床症状的男性吸烟者肺部HRCT征象的分析

Analysis of Lung HRCT Signs of Male Smokers without Clinical Symptoms Aged more than 50

目的研究无临床症状男性肺老化伴或不伴吸烟的肺部HRCT征象,提高对肺老化及吸烟后肺改变的认识。方法整群选取2015年5月—2016年3月来该院放射科进行健康体检且无胸部症状及无胸部疾病史的50岁以上的145名男性进行HRCT扫描,根据有无吸烟史将研究对象分为非吸烟组(49名)和吸烟组(96名),并根据吸烟指数不同将吸烟组分为3个亚组:吸烟A组(29名,吸烟指数<400)、吸烟B组(31名,400≤吸烟指数<800)和吸烟C组(36名,吸烟指数≥800)。观察的肺部征象包括:肺气肿、肺结节、磨玻璃影、支气管管壁增厚、支气管扩张、马赛克样灌注、小叶间隔增厚、异常网状影、实变、钙化灶,并对肺气肿程度及分布进行定量分析,对各个指标进行统计学分析。结果无症状胸部体检者肺部出现率较高的影像学征象为小叶间隔增厚和肺气肿,分别为57.24%及51.03%。马赛克样灌注征象在非吸烟组的阳性率最高,为38.78%。吸烟C组的肺气肿分值的第75百分位数高于其余各组。各吸烟组内上、中、下肺野肺气肿分值的差异无统计学意义。而在非吸烟组内,下肺野肺气肿分值的第75百分位数高于中肺野,中肺野肺气肿分值的第75百分位数高于上肺野。结论肺老化及吸烟肺的影像学征象有不少相似之处,马赛克样灌注征象、肺气肿的程度及分布可用于肺老化及吸烟肺的鉴别。

Objective To research the lung HRCT signs of male lung aging with or without smoking thus improving the awareness of lung aging and lung changes after smoking.Methods Group selection 145 cases of males over 50 years old with chest symptoms and without chest disease history in our hospital from May 2015 to March 2016 were for healthy physical examination and divided into two groups according to whether they had the smoking history or not,namely the non-smoking group with 49 cases and smoking group with 96 cases and the smoking group were divided into three subgroups according to different smoking indexes,the smoking group A（29 cases,smoking index 400）,smoking group B（31 cases,400≤smoking index800） and smoking group C（36 cases,smoking index ≥800）,and the lung signs included that emphysema,pulmonary nodules,ground glass opacity,bronchial wall thickening,bronchiectasis,mosaic like perfusion,interlobular septal thickening,abnormal reticular shadow,consolidation,calcification,and the emphysema degree and distribution were given the quantitative analysis,and various indexes were statistically analyzed.Results The imaging signs whose lung occurrence rate was higher in chest physical examiners without symptoms were interlobular septal thickening and emphysema,respectively accounted for 57.24% and 51.03%,and the positive rate of mosaic perfusion sign in the non-smoking group was the highest（38.78%）,and the 75 th % of emphysema score in the smoking C group was higher than that in the other groups,and the differences in the upper,middle and lower lung emphysema scores between various smoking groups had no statistical significance,but in the non-smoking group,the 75 th % of lower lung emphysema score was higher than that of middle lung emphysema score and the 75 th % of middle lung emphysema score was higher than that of upper lung emphysema score.Conclusion There are many similarities between imaging signs of lung aging and smoking lung,and the mosaic perfusion sign,emphysema degree and distribution can be used to identify the lung aging and smoking lung.