慢性阻塞性肺疾病急性加重患者不同低密度区分级临床特点分析

The assessment of clinical characteristics between different LAA phenotype in patients with acute exacerbation in chronic obstructive pulmonary disease

目的探讨低密度区(LAA)分级方法对慢性阻塞性肺疾病(简称慢阻肺)急性加重患者进行影像分型的可行性及其临床应用价值。方法纳入380例住院慢阻肺急性加重患者并采集住院期间的一般资料、实验室检查资料及治疗相关资料等信息,根据其高分辨率CT(HRCT)的影像学表现,采用LAA分级方法分为支气管炎型及肺气肿型,通过比较两组间临床资料分析不同慢阻肺亚型间的差异及该分级方法的可行性。结果支气管炎型患者的体重指数水平更高,入院时C反应蛋白、白细胞介素-6、降钙素原、中性粒细胞与淋巴细胞绝对计数比、嗜酸性粒细胞计数水平均较肺气肿型高(P<0.05);肺气肿型患者中男性占比更高,吸烟指数更高,入院时胆红素水平更低,胱抑素C水平更高(P<0.05),使用呼吸机及全身糖皮质激素的比例也更高(P<0.05);LAA分级与是否使用呼吸机、是否使用全身糖皮质激素及胱抑素C水平存在正相关,与白细胞介素-6水平存在负相关(P<0.05)。结论对慢阻肺急性加重患者而言,使用LAA分级方法对其HRCT进行影像学分型存在一定的准确性及临床实用性。LAA分级方法有助于一定程度上对患者的病情及预后进行评估。

Objective To explore the feasibility and clinical application value of low attenuation areas(LAA) scoring system in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 380 patients with AECOPD were included.Clinical data including general information,laboratory examinations and treatments during hospitalization were collected.According to the high-resolution computed CT(HRCT)imaging performance,the patients were divided into bronchitis phenotype and emphysema phenotype.The clinical data between these two groups were compared to analyze the differences between different phenotypes and the feasibility of LAA scoring system.Results In patients of bronchitis phenotype,the levels of body mass index,C-reactive protein,interleukin-6,procalcitonin,neutrophil-to-lymphocyte ratio,and eosinophil counts on admission were higher than those of emphysema phenotype(P<0.05).Patients with emphysema phenotype had a higher proportion of male,a higher smoking index,higher cystatin C levels and lower bilirubin levels on admission(P<0.05),the rates of using mechanical ventilation and systemic glucocorticoids were higher as also(P<0.05).LAA scores had a positive correlation with the use of mechanical ventilation and systemic glucocorticoids and cystatin C levels,and a negative correlation with interleukin-6 levels(P<0.05).Conclusions For patients with AECOPD,using LAA scoring system to classify different phenotype through HRCT has relevant accuracy and clinical practicability.The LAA scoring system might help to evaluate the patient’s condition and prognosis to a certain extent.