慢性阻塞性肺疾病患者胸部定量CT参数与肺功能检测指标相关性分析

Correlation between quantitative CT parameters and pulmonary function in patients with chronic obstructive pulmonary disease

目的评估慢性阻塞性肺疾病(COPD)患者胸部定量CT参数与肺功能检测(PFT)指标的相关性。方法研究对象为185例COPD患者,根据全球慢性阻塞性肺病倡议(GOLD)分为Ⅰ-Ⅳ型。采用定量CT检测不同GOLD分期患者肺气肿指数(EI)、空气潴留指数和气道相关参数。采用Pearson相关评估CT参数与PFT指标之间的相关性,包括1秒用力呼气量与用力肺活量(FEV 1/FVC)比值和FEV 1。采用多元线性回归分析评估CT参数是否可用于预测PFT指标。结果GOLDⅢ和Ⅳ患者肺实质衰减参数较差(P<0.001),GOLDⅢ患者气道内周径为10mm时的管壁厚度(Pi10)最高。气道参数与PFT指标呈非线性相关(P<0.05),GOLDⅡ、Ⅲ型患者Pi10与FEV 1/FVC呈轻度相关(P<0.05)。在GOLDⅠ和Ⅱ患者中,肺实质衰减参数、气道参数、EI和Pi10是FEV 1/FVC预测因子(P<0.001)。在GOLDⅢ和Ⅳ患者中,实质性衰减参数和EI是FEV 1/FVC预测因子(P<0.001)。FEV 1也有类似的结果。结论气道和实质衰减参数是GOLDⅠ和Ⅱ患者肺功能独立预测因子,而实质衰减参数是GOLDⅢ和Ⅳ患者肺功能独立预测因子。

Objective To evaluate the correlation between quantitative computed tomography(CT)parameters and pulmonary function test(PFT)parameters in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 185 patients with COPD were grouped based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease(GOLD)Ⅰ-Ⅳcriteria.Emphysema index(EI),air-trapping index,and airway parameters were measured using quantitative CT.The correlation between CT parameters and PFT indices,including the ratio of forced expiratory volume in one second to forced vital capacity(FEV 1/FVC)and FEV 1,was assessed by Pearson correlation.Whether CT parameters could be used to predict PFT indices was analyzed by multiple linear regression.Results Parenchymal attenuation parameters were significantly worse in patients with GOLDⅢandⅣ(P<0.001),and the hypothetical airway with internal perimeter of 10mm(Pi10)was the highest for patients with GOLDⅢ.Airway parameters were non-linearly correlated with PFT results,and Pi10 demonstrated mild correlation with FEV 1/FVC in patients with GOLDⅡandⅢ(P<0.05,respectively).Parenchymal attenuation parameters,airway parameters,EI,and Pi10 were identified as predictors of FEV 1/FVC for GOLDⅠandⅡ(P<0.001).However,only parenchymal attenuation parameter,EI,was identified as a predictor of FEV 1/FVC for GOLDⅢandⅣ(P<0.001).Similar results were obtained for FEV 1.Conclusion Airway and parenchymal attenuation parameters are independent predictors of pulmonary function in patients with GOLDⅠandⅡ,whereas parenchymal attenuation parameters are dominant independent predictors of pulmonary function in patients with GOLDⅢandⅣ.