COPD急性加重患者肺小血管改变及其临床价值

Changes of Small Pulmonary Vascular in Patients with Acute Exacerbation of COPD and Clinical Value

目的:探讨肺小血管与COPD严重程度、急性加重发生的关系及其在评估COPD合并肺动脉高压的作用。方法:收集住院期间同时行胸部CT、超声心动图及肺功能检查的COPD急性加重期患者,且缓解期再次行胸部CT检查者纳入研究。比较急性加重期和缓解期%CSA_(<5)肺小血管变化。结果:共30例COPD患者纳入研究。%CSA_(<5)COPD急性加重期(0.44±0.11)与缓解期(0.61±0.15)相比减少且差异有统计学意义(t=-8.231,P=0.000)。根据超声结果分组PH组14人,非PH组16人。%CSA_(<5)PH组(0.48±0.12),与非PH组(0.39±0.09)相比增加且差异有统计学意义(t=2.153,P=0.040)。按照肺功能严重程度分为轻度(5例),中度(15例)、重度和极重度(10例),随着COPD严重程度的增加,%CSA_(<5)下降。结论:CT定量测量COPD患者肺小血管不仅可以反映COPD严重程度,同时还可反映COPD合并PH的严重程度、提示急性加重的发生,可为COPD患者的病情评估提供新的依据。

Objective： To investigate the relationship between small pulmonary vascular and the severity and acute exacerbation of chronic obstructive pulmonary disease （COPD） and its role in the assessment of COPD with pulmonary hypertension. Methods： The patients underwent chest CT, echocardiography and pulmonary function test during the acute exacerbation and remission of COPD were included in this study. %CSA〈s was compared between acute exacerbation and remission of COPD. Results： A total of 311 COPD patients were included. The %CSA〈s of acute exacerbation was （0.44±0.11）, which was lower than that of remission period （0.61±0.15）, and the difference was statistically significant （t=-8.231, P=0.000）. According to the ultrasound results, patients were divided into two groups, PH group14 patients and non-PH group 16 patients. The %CSA〈5 of PH group was （0.48 ±0.12）, which was higher than that of non-PH group （0.39± 0.09）, and the difference was statistically significant （t-=2.153, P=0.040）. Patients were divided into mild （S cases）, moderate （15 cases）, severe and extreme severe （10 cases） according to the severity of lung function. %CSA〈5, was decreased with the increase of COPD severity. Conclusion： CT quantitative measurement of puhnonary small vessels in COPD patients can not only reflect the severity of COPD, but also the severity of PH, indicating the occurrence of acute exacerbation, which can provide new evidence for evaluating the condition of COPD.