基于CT定量探讨不同级别慢性阻塞性肺疾病患者肺气肿肺叶分布

Emphysema lobar distribution in patients with different degrees of chronic obstructive pulmonary disease based on quantitative CT analysis

目的探讨不同级别慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者肺气肿肺叶分布的特点。方法收集COPD患者61例及正常对照90例,均行吸气相及呼气相CT扫描,COPD患者分为轻度组(COPD 1级与2级)和重度组(COPD 3级与4级)。所得图像导入"数字肺"自动检测平台进行分析,肺气肿肺叶分布情况以各肺叶低密度区(low attenuation area, LAA)容积占全肺低密度区容积的百分比(percentage of LAA, LAA%)表示,低于-910 HU和-950 HU为肺气肿。采用SPSS 22.0方差分析比较各组间LAA%的差异。结果吸、呼气相中,轻度COPD组较正常组右肺上叶的LAA-910%及LAA-950%明显增加,右肺中叶的LAA-910%及LAA-950%显著减少,差异有统计学意义(P<0.05)。与轻度COPD组比较,吸、呼气相中,重度COPD组均有双肺下叶LAA-910%及LAA-950%显著增加,左肺上叶LAA-910%及LAA-950%显著减少;呼气相中,另有右肺上叶LAA-910%及右肺中叶的LAA-910%及LAA-950%显著减小,差异有统计学意义(P<0.05)。吸、呼气相中,重度COPD组较正常组右肺中叶及左肺上叶的LAA-910%及LAA-950%显著减小,左肺下叶的LAA-910%及LAA-950%显著增加;呼气相中,另有右肺上叶及下叶的LAA-910%及LAA-950%显著增加,差异有统计学意义(P<0.05)。结论轻度COPD患者的肺气肿在两上肺比例较大,重度COPD患者肺气肿在两下肺所占的比例明显增加。

Objective To explore the features of emphysema lobar distribution in patients with chronic obstructive pulmonary disease(COPD)of different degrees.Methods Sixty-one COPD patients and ninety normal controls were recruited.CT scanning of both inspiratory and expiratory phase was performed.The COPD patients were divided into mild COPD group(levels 1 and 2)and severe COPD group(levels 3 and 4).All images were imported into the digital lung automatic detection platform,and emphysema lobar distribution was defined as percentage of lobar low attenuation area(LAA)in the total lung low attenuation area(LAA%),-910 HU and-950 HU were two cut-off values for emphysema.SPSS 22.0 Covariance Analysis was used for LAA%comparison among the groups.Results In both inspiratory and expiratory phases,compared with those of normal controls,LAA-910%and LAA-950%of the right upper lobe increased significantly,LAA-910%and LAA-950%of the right middle lobe decreased significantly in mild COPD group(P<0.05).In the inspiratory phase,compared with that in mild COPD group,LAA-910%and LAA-950%of the bilateral lower lobe increased and LAA-910%and LAA-950%of the left upper lobe decreased in severe COPD group,and these changes had significant differences(P<0.05),and additional significant decrease was found in expiratory phase in LAA-910%of the right upper lobe,LAA-910%and LAA-950%of the right middle lobe in severe COPD group.In the inspiratory phase,compared with those of the normal controls,LAA-910%and LAA-950%of the right upper and middle lobes decreased and LAA-910%and LAA-950%of the left lower lobe increased in severe COPD group,and these changes had significance(P<0.05),and additional significant increase was found in expiratory phase in LAA-910%and LAA-950%of the right upper and the lower lobes in severe COPD group.Conclusion Emphysema in mild COPD patients is more obvious in the bilateral upper lobe and increases gradually with the increase of COPD grade.