定量CT对肺泡蛋白沉着症患者支气管肺泡灌洗的效果的评价

Evaluation of the Effect of Quantitative CT on Bronchoalveolar Lavage in Patients with Pulmonary Alveolar Proteinosis

【目的】探讨定量计算机断层扫描（CT）对肺泡蛋白沉着症（PAP）患者支气管肺泡灌洗术（BAL）治疗效果的评估价值。【方法】选择本院收治的30例PAP患者的临床资料，所有患者均行BAL治疗。于治疗前后采用肺功能检测仪测定患者的肺功能指标[用力肺活量（FVC）、一氧化碳弥散量（DLCO）、第1秒用力呼气量（FEVl）、最大通气量实测值（MVV）／预计值百分比，即FVC％、DLCO％、FEVl％、MVV％]。比较治疗前后患者的肺换气功能指标[动脉血氧分压（PaO2）和动脉二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）]；采用定量CT检测肺部平均密度数值、肺部气体总容积、肺部总质量、平均CT数值等；采用MMRC评分评估呼吸困难程度，6min步行试验评价患者的呼吸困难症状及运动耐力。【结果IBAL术前后FVC％、FEVl％、PaCO2值比较，差异均具有统计学意义（P〉0．05），BAL术后DLCO％、MVV％、PaO2、SaO2值较BAL术前均有明显升高，差异均具有统计学意义（P〈0．05）。肺平均CT值、双肺总重量、肺平均密度数值均较BAL术前均明显降低（P〈0．05），肺气体总容积较BAL术前明显升高，差异均具有统计学意义（P〈0．05）。BAL术后患者的MMRC评分较BAL术前明显降低，6min步行距离较BAL术前明显升高，差异均具有统计学意义（P〈0．05）。【结论】BAL术治疗PAP临床效果较佳，定量CT可较好的评估肺泡灌洗术治疗效果。

[Objective]To explore the result of quantitative computed tomography （CT） and its clinical signifi- cance on patients with pulmonary alveolar proteinosis （PAP） after bronohoalveolar lavage. [Methods]The clinical data of 30 patients with PAP were selected. All patients were treated with BAL.The pulmonary function indexes of patients were measured by pulmonary function test before and after treatment [forced vital capacity （FVC）, car- bon monoxide diffusion volume （DLCO）, forced expiratory volume （FEV1） in 1 second, maximum ventilation value （MVV） / percentage of predicted value. That is, FVC%, DLCO%, FEVI% ,MVV%].Pulmonary ventila- tion function indexes [arterial oxygen / carbon dioxide partial pressure （PaO2 and PaCO2 ）, blood oxygen satura- tion （SaO2）] were compared before and after treatment. The mean density of lung, the total volume of lung gas, the total mass of lung, the mean value of CT and so on were measured by quantitative CT. MMRC score was used to evaluate the degree of dyspnea. 6 min walking test was used to evaluate dyspnea symptoms and exercise endur- anee.[Results]The difference of FVC%, FEVI%, PaCO2 before and after BAL was statistically significant （ P〈 0.05）. The DLCO%, MVV%, PaO2, SaO2 value after BAL was significantly higher than that before BAL （ P 0.05）. The mean lung CT value, total lung weight and lung density were significantly lower than those before BAL （ P 〈0.05）. The total volume of lung gas was significantly higher than that before BAL （ P 〈0.05）. The MMRC score of patients after BAL was significantly lower than that before BAL, and the 6 min-walking distance was sig- nificantly higher than that of BAL （ P 〈0.05）. [Conclusion]The clinical effect of BAL in the treatment of PAP is better. Quantitative CT can be used to evaluate the effect of bronohoalveolar lavage.