肺叶低密度区容积百分比对慢性阻塞性肺病患者肺功能受损程度的评估作用

Evaluation of severity of lung function damage in COPD patients by LAA%

目的:分析低密度区容积百分比(LAA%)对慢性阻塞性肺疾病(COPD)患者肺功能受损程度的评估。方法:选取COPD患者60例作为试验组,再按照《慢性阻塞性肺疾病诊断标准(WS 318-2010)》将其划分为GOLD 1级轻度(FEV_1/FVC<70%、FEV_1≥80%)15例、GOLD 2级中度(FEV_1/FVC<70%、50%≤FEV_1<80%)17例、GOLD 3级重度(FEV_1/FVC<70%、30%≤FEV_1<50%)20例、GOLD 4级超重度(FEV_1<30%)8例,同时,选择健康体检者28例作为对照组。对2组均行肺部CT检查,测量和计算出各个肺叶的LAA%、行肺功能检查以测量和计算出FEV_1%、FEV_1/FVC、RV/TLC、DLCO%,运用线性回归分析LAA%与FEV_1%、FEV_1/FVC、RV/TLC、DLCO%的关系、运用协方差分析比较不同的LAA%。结果:全肺各区的LAA%与FEV_1%、FEV_1/FVC差异均有统计学意义(P<0.05),其中,左肺下叶LAA%与FEV_1%关系最密切、右肺下叶LAA%与FEV_1/FVC关系最密切;除了右肺中下叶的LAA%与DLCO%、RV/TLC差异无统计学意义(均P>0.05)外,其他肺叶区的LAA%与DLCO%、RV/TLC差异均有统计学意义(均P<0.05),其中左肺下叶LAA%与DLCO%、RV/TLC关系最密切;且随着COPD的级别越高,FEV_1%、FEV_1/FVC、DLCO%值越低(均P<0.05),对照组的FEV_1%、FEV_1/FVC、DLCO%均比试验组高;试验组中GOLD 1组的右肺LAA%、右肺上叶LAA%及总LAA%与对照组比较差异均有统计学意义(均P<0.05),GOLD 2、GOLD 3、GOLD 4与对照组间全肺及各肺叶间均具有显著差异(均P<0.05)。结论:COPD患者肺叶LAA%可反映出肺功能的受损程度,且LAA%越高受损程度越重。

Objective：To evaluate the severity of lung function damage in COPD patients by LAA% of each lung lobe which was measured by MSCT.Methods：Sixty patients with COPD in our hospital during 2015 to 2016 were randomly selected as experimental group,and according to ＂ diagnosis criteria for chronic obstructive pulmonary disease（WS 318-2010） ＂,15 cases were fallen into COPD GOLD 1（FEV1/FVC70%,and FEV1≥80%）,17 cases into COPD GOLD 2（FEV1/FVC70%,and 50%≤FEV180%）,20 cases into COPD GOLD 3（FEV1/FVC70%,and 30%≤FEV150%）,and 8 cases into COPD GOLD 4（FEV130%）.Twenty healthy volunteers served as control group.All subjects were checked with pulmonary CT examination to measure and calculate LAA% of each lung lobe,and all the subjects were checked with pulmonary function examination to measure and calculate FEV1%,FEV1/FVC,RV/TLC,DLCO%.The linear regression analysis was used to study the relationship of LAA% with FEV1%,FEV1/FVC,RV/TLC or DLCO%,and we used covariance analysis to compare the difference of LAA% in different lung lobes.Results：LAA% of whole lung regions was significantly correlated with FEV1% and FEV1/FVC（P〈0.05）.LAA% of the lower lobe of left lung was most closely correlated with FEV1%,and LAA% of the lower lobe of right lung was most closely correlated with FEV1/FVC.Except the middle and lower lobes of right lung,LAA% in the rest lung regions was significantly correlated with DLCO% and RV/TLC（P〈0.05）.LAA% of the lower lobe of left lung was most closely correlated with DLCO% and RV/TLC.The more the COPD aggravated,the lower FEV1%,FEV1/FVC and DLCO% values were（P〈0.05）.FEV1%,FEV1/FVC and DLCO% values in the control group were higher than in the experimental group.There was significant difference in LAA% of the right lung,right upper lobe and total between the GOLD 1 subgroup and control group（P 0.05）.Besides,there were significant differences between GOLD 2,GOLD 3,GOLD 4 subgroups and the control group in LAA% of the whole lung and each lung lobe（P 0.05）.Conclusion：LAA% could reflect the severity of lung function damage in COPD patients.The higher LAA% is,the more serious the lung function damage is.