慢性阻塞性肺疾病急性加重期患者CT肺血管参数与病情严重程度的相关性研究

Correlation between CT pulmonary vascular parameters and severity in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者胸部高分辨率CT(HRCT)的肺血管参数与临床病情严重程度的关系。方法收集2016年1月至2018年1月于山西医科大学附属大医院呼吸与危重症医学科住院的60例AECOPD患者的临床资料,包括生命体征、动脉血气分析、既往1年内急性加重次数及入院期间的胸部HRCT影像资料。根据其临床表现及动脉血气分析分为轻度(无呼吸衰竭)、中度(急性呼吸衰竭-无生命危险)及重度组(急性呼吸衰竭-有生命危险)。根据过去1年中急性加重次数分为频繁急性加重(≥2次/年)和非频繁急性加重(<2次/年)2组。测量胸部HRCT肺小血管横截面积(<5 mm2)与肺野总面积比值(%CSA<5)及肺动脉与主动脉横截面直径的比(PA/A),分析各组间%CSA<5和PA/A差异性及不同急性加重频率分组间胸部HRCT肺血管参数的比较,并分析AECOPD患者%CSA<5与PA/A及临床指标的相关性。结果(1)轻、中、重度每组各20例,3组间性别、年龄及吸烟指数差异均无统计学意义。(2)3组间%CSA<5差异有统计学意义(F=5.918,P<0.05),且重度组[(0.54±0.14)%]%CSA<5明显小于轻度[(0.68±0.16)%]和中度组[(0.67±0.13)%](t=3.031、2.978,P值均<0.05),3组间PA/A差异无统计学意义(F=2.560,P>0.05)。与非频繁急性加重组[(0.69±0.16)%]相比,频繁急性加重组[(0.58±0.13)%]%CSA<5明显减少,差异有统计学意义(t=2.881,P=0.006)。(3)AECOPD患者%CSA<5与动脉血pH值、PaO2呈正相关,与急性加重频率、PaCO2及PA/A呈负相关(r=0.372、0.328、-0.363、-0.342、-0.323,P值均<0.05)。结论重度及频繁急性加重COPD患者胸部HRCT肺小血管横截面积显著下降,提示%CSA<5可能成为评估AECOPD患者临床病情严重程度的有效指标。

Objective To explore the relationship between pulmonary vascular parameters in chest high-resolution CT (HRCT) and clinical severity in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Collected 60 cases′ clinical data of AECOPD patients between January 2016 and January 2018 from Department of Respiratory and Critical Care Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, including vital signs, arterial blood gas analysis, times of acute exacerbations in the previous year and chest HRCT image data during admission.It was divided into mild (no respiratory failure), moderate (acute respiratory failure-no life danger) and severe group (acute respiratory failure-life danger) according to its clinical and arterial blood gas analysis.It was divided into two groups of frequent acute exacerbation (≥2 times/year) and nonfrequent acute exacerbation (<2 times/year) according to that acute exacerbation times in the previous year.Measurement of chest HRCT cross-sectional area of small pulmonary vessels<5 mm2 as a percentage of total lung area (%CSA<5), and ratio of the diameter of the pulmonary artery to that of the aorta (PA/A), analysis %CSA<5 and PA/A differences of each group, and comparison of pulmonary vascular parameters in chest HRCT between different acute exacerbation frequencies groups, and analysis of %CSA<5 of AECOPD patients with PA/A and clinical indicators. Results (1)There were 20 cases in each group of mild, moderate and severe, and no significant difference in gender, age and smoking index between the three groups.(2)The difference of %CSA<5 between the three groups was statistically significant (F=5.918, P<0.05),%CSA<5 of severe group [(0.54±0.14)%] was significantly less than mild [(0.68±0.16)%] and moderate group [(0.67±0.13)%](t=3.031, 2.978, both P<0.05). No statistically significant difference in PA/A between the three groups (F=2.560, P>0.05). Compared with nonfrequent acute exacerbation group [(0.69±0.16)%],%CSA<5 of frequent acute exacerbation group [(0.58±0.13)%] decreased significantly, the difference was statistically significant (t=2.881, P=0.006).(3)%CSA<5 of AECOPD patients was significantly positively correlated with arterial pH value and oxygen partial pressure, and significantly negatively correlated with acute exacerbation frequency, carbon dioxide partial pressure and PA/A (r=0.372, 0.328,-0.363,-0.342,-0.323, all P<0.05). Conclusions The cross sectional area of small pulmonary vessels in chest HRCT is significantly decreased in AECOPD patients of the severe group and the frequent acute exacerbation group.Suggest that %CSA<5 may be an effective indicator to assess the clinical severity of COPD and play a significant guiding role in the diagnosis and treatment during the AECOPD.