定量CT对比观察轻-中度慢性阻塞性肺疾病及哮喘

Comparison of mild-to-moderate chronic obstructive pulmonary disease and asthma with quantitative CT

目的观察稳定期轻-中度慢性阻塞性肺疾病(COPD)与哮喘患者近端气道结构及CT肺功能的差异。方法对30例轻-中度COPD患者(mtmCOPD组)、30例轻-中度哮喘患者(mtmAs组)及30名健康对照者(健康对照组)行低剂量呼吸双相CT扫描及定量分析,比较其近端气道参数、肺气肿及空气潴留指数的差异。结果mtmCOPD组与mtmAs组近端气道平均管腔面积(LA)/体表面积(BSA)分别为(10.93±2.58)mm^2/m^2和(10.81±3.20)mm^2/m^2,均小于健康对照组的(12.56±2.98)mm^2/m^2,mtmAs组与健康对照组差异有统计学意义(P=0.04);mtmCOPD组和mtmAs组平均管壁面积百分比(WA%)分别为(63.02±2.34)%和(63.85±2.48)%,均大于健康对照组的(61.55±3.54)%,mtmAs组与健康对照组差异有统计学意义(P<0.01)。mtmCOPD组呼吸双相VI-910(%)及VI-950(%)均大于健康对照组(P均<0.01),呼气相平均肺密度(MLD)绝对值、呼气相VI-856(%)及MLD E/I均大于健康对照组(P均<0.05)。mtmCOPD组与mtmAs组气道结构参数、肺气肿及空气潴留指数差异均无统计学意义(P均>0.05)。结论轻-中度COPD及哮喘患者近端支气管管腔面积较健康对照者均有缩小,近端气道管壁面积百分比较健康对照者均有增大,且轻-中度哮喘患者更加明显。轻-中度COPD患者存在明显肺气肿及空气潴留。

Objective To investigate the differences of proximal airway structure and CT pulmonary function between steady mild-to-moderate chronic obstructive pulmonary disease(COPD)and asthma patients.Methods Thirty patients with mild-to-moderate COPD(mtmCOPD group),30 patients with mild-to-moderate asthma(mtmAs group)and 30 healthy controls(normal control group)underwent low-dose paired inspiratory and expiratory CT scans and quantitative analysis.The differences of airway parameters,emphysema index and air trapping index were analyzed among 3 groups.Results The mean lumen area(LA)/body surface area(BSA)of the proximal airway of both mtmCOPD group and mtmAs group([10.93±2.58]mm^2/m^2,[10.81±3.20]mm^2/m^2)were lower than that of normal control group([12.56±2.98]mm 2/m 2),and statistically significant difference was found between mtmAs group and normal control group(P=0.04).The mean WA%of both mtmCOPD group and mtmAs group([63.02±2.34]%,[63.85±2.48]%)were higher than that of normal control group([61.55±3.54]%),while statistically significant difference was observed between mtmAs group and normal control group(P<0.01).The paired inspiratory and expiratory VI-910(%)and VI-950(%)of mild-to-moderate COPD were higher than those of healthy controls(all P<0.01).The expiratory absolute value of mean lung density(MLD),expiratory VI-856(%)and MLD E/I of mtmCOPD group were also higher than those of normal control group(all P<0.05).There was no significant difference in airway structural parameters,emphysema nor air trapping index between mtmCOPD group and mtmAs group.Conclusion The lumen area of proximal bronchus of mild-to-moderate COPD and asthma patients were both smaller than that of healthy controls to a certain extent.Meanwhile,their percentage of proximal airway wall area were both larger than that of healthy controls,which were more obviously in patients with mild-to-moderate asthma.There were obvious emphysema and air trapping in mild-to-moderate COPD patients than in healthy subjects.