CT定量分析与慢性阻塞性肺疾病骨骼肌变化的相关性分析

Correlation Analysis of CT Quantitative Analysis and Changes of Chest Muscle in COPD Patients

目的对于慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者行胸部CT检查,并评估骨骼肌面积与COPD的相关性,判定胸大肌面积大小与COPD患者急性加重期和体重指数的相关性。方法对ECLIPSE组共73人被纳入研究评估病人进行胸大肌面积和测量去脂肪体重的相关性分析;对COPD基因组966例基因遗传流行病学COPD实验者进行胸大肌面积与临床特点相关性分析。由放射医师在双盲下定量评估病例组和对照组胸大肌面积。结果在ECLIPSE组中,胸大肌区域与去脂体重的相关性R2为0.76。COPD实验组胸大肌面积低于对照组,在COPD基因组具有统计学意义。所有实验组胸大肌面积增大具有较高一秒用力呼气容积(FEV1)、用力肺活量(FVC),通过FEV1/FVC比值测定,表现很少有气道阻塞。在校正年龄、性别、身高、吸烟史后,显示胸大肌面积每增大1 cm2,与FEV1预测值相关性显著增加0.81%(95%CI为0.63~0.99,P<0.001);另外,胸大肌面积每增大1 cm2,与肺气肿相关性减少0.63%(95%CI为-0.7^-0.51,P<0.001)。CT测量与胸大肌与SGRQ总分和SGRQ活动评分、Sp O2水平、6 min步行距离、BODE指数评分、MMRC呼吸困难评分和疾病加重期具有相关性。结论 CT测量检查胸大肌横断面积表明与COPD的严重性具有相关性,同时测量胸大肌面积能预测COPD的急性加重期过程及严重程度。

Objective To evaluate the correlation between chest muscle area and chronic obstructive pulmonary disease(COPD)in patients with COPD,and to determine the correlation between the size of the chest muscle area and the acute exacerbation period and the body mass index of patients with COPD.Methods A total of73cases in ECLIPSE group were included in the study to evaluate the association between the pectoralis major muscle and fat weight measurement.For COPD genetic group,a total of966COPD subjects were included to analyze the correlation between the pectoralis major area and clinical characteristics.The area of chest muscle was evaluated by the radiologists in a double blind.Results In the ECLIPSE group,the R2correlation between the pectoralis major muscle area and lean body weight was0.76.COPD experimental group of pectoralis major area was lower than that of the control group,with statistical significance in COPD genome.The entire experimental group had higher forced expiratory volume(FEV1)and forced vital capacity(FVC).The FEV1/FVC ratio showed there was very little airway obstruction.After correction of the age,gender,height and smoking history,the FEV1predictive value of correlation was significantly increased by0.81%(95%CI0.63-0.99,P<0.001)when the pectoralis major muscle area increased by1cm2.Correspondingly,the correlation of emphysema decreased by0.63%(95%CI-0.7-0.51,P<0.001).CT quantitative analysis was significantly associated with SGRQ score,SpO2score,SGRQ level,6min walk distance,BODE index score,MMRC dyspnea score and disease exacerbation.Conclusion There is correlation between the CT measurement of the cross-sectional area of the large chest muscle and the severity of COPD.Besides,the measurement of the area of the chest muscle can predict the course and severity of acute exacerbation of COPD.