慢性阻塞性肺疾病剑鞘样气管与肺功能相关性的研究

Study on the correlation between saber-sheath trachea and lung function in chronic obstructive pulmonary disease

目的探讨剑鞘样气管改变的慢性阻塞性肺疾病(简称慢阻肺)患者的气管指数与肺功能及动脉血二氧化碳分压的相关性。方法根据剑鞘气管的标准,选取具有剑鞘样气管改变的慢阻肺患者69例,男性66例,女性3例,在主动脉弓上10 mm处应用计算机测量软件测量冠状径及矢状径,计算其气管指数。分析气管指数与肺功能的相关性。抽取这些患者的动脉血,检测其二氧化碳分压,分析气管指数与二氧化碳分压的关系。结果剑鞘样气管内冠状径的长度范围是5.7~16.8 mm,均值11.8±2.5 mm;矢状径的长度范围是15.3~27.1 mm;均值21.9±2.6 mm;气管指数范围0.28~0.66,均值0.54±0.91;气管指数与FEV 1/FVC%呈正相关(r=0.563,P<0.001),与FEV 1Pred%呈正相关(r=0.421,P<0.001),MMEF呈正相关(r=0.335,P=0.005),与VC%呈正相关(r=0.238,P=0.049)、二氧化碳分压呈负相关(r=-0.313,P=0.009);当气管指数<0.587时,慢阻肺分级为极重度,敏感度47.5%,特异度100.0%;当气管指数<0.595时,慢阻肺分级为重度,敏感度54.8%,特异度73.7%。结论薄层肺CT可以精确计算气管指数,可用来初步评估慢阻肺患者肺功能阻塞的严重程度及预估动脉血二氧化碳分压数值。

Objective To investigate the correlation between tracheal index and lung function and arterial partial pressure of carbon dioxide in patients with chronic obstructive pulmonary disease(COPD)with saber-sheath tracheal changes.Methods According to the criteria of saber-sheath trachea,69 COPD patients(66 males and 3 females)with saber-sheath tracheal changes were selected.The coronal diameter and sagittal diameter were measured with computer measurement software at 10 mm above the aortic arch,and the tracheal index was calculated.The correlation between tracheal index and lung function was analyzed.Arterial blood was drawn from these patients,their partial pressure of carbon dioxide was measured,and the relationship between tracheal index and partial pressure of carbon dioxide was analyzed.Results The length of saber-sheath trachea coronal diameter ranged from 5.7 to 16.8 mm,with a mean of 11.8±2.5 mm.The length of sagittal diameter ranged from 15.3 to 27.1 mm,with a mean of 21.9±2.6 mm.The tracheal index ranged from 0.28 to 0.66,with a mean of 0.54±0.91.The tracheal index was positively correlated with FEV 1/FVC%(r=0.563,P<0.001),positively correlated with FEV 1Pred%(r=0.421,P<0.001),positively correlated with MMEF(r=0.335,P=0.005),positively correlated with VC%(r=0.238,P=0.049),and negatively correlated with partial pressure of carbon dioxide(r=0.313,P=0.009).When the tracheal index was<0.587,COPD was very severe,with a sensitivity of 47.5%and a specificity of 100.0%.When the tracheal index was<0.595,COPD was severe,with a sensitivity of 54.8%and a specificity of 73.7%.Conclusion Thin-section lung CT can accurately calculate the tracheal index,which can be used to preliminarily evaluate the severity of lung function obstruction and predict the arterial partial pressure of carbon dioxide in patients with COPD.