慢性阻塞性肺疾病各中医证型的CT肺功能评估及临床肺功能检查参数分析

Parameter analysis of CT pulmonary function assessment and clinical pulmonary function test of COPD TCM syndrome differentiation

目的:对慢性阻塞性肺疾病(COPD)患者行CT肺功能评估,探究其与肺功能检查的相关性,并分析比较COPD各中医证型的肺功能参数与CT肺功能评估结果,为COPD中医辨证提供参考依据。方法:根据COPD中医诊断标准对其进行分型,完成肺功能、CT检查,并对CT图像进行三维重建,计算肺气肿指数(LAA%)。结果:痰浊壅肺证、痰热蕴肺证、痰瘀阻肺证、肺肾气虚证之间第1秒用力呼气容积占预计值百分比(FEV1占预计值%)及第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC%)比较差异均有统计学意义(均P<0.01),FEV1占预计值%、FEV1/FVC%由痰浊壅肺证→痰热蕴肺证→痰瘀阻肺证→肺肾气虚证逐渐变小;LAA%由痰浊壅肺证→痰热蕴肺证→痰瘀阻肺证→肺肾气虚证逐渐增大。LAA%与FEV1占预计值%呈负相关(r=-0.775,P=0.001);LAA%与FEV1/FVC%呈负相关(r=-0.458,P=0.001)。结论:CT肺功能评估与临床肺功能检查之间呈负相关,随着肺通气功能的降低,COPD患者的LAA%随之升高,说明CT评估肺功能是可行的。COPD各中医证型之间LAA%、肺功能参数存在差异,可为COPD辨证分型提供一定的参考价值。

Objective:Based on the good resolution of CT,CT lung function assessment was performed on chronic obstructive pulmonary disease(COPD)patients to explore the correlation with clinical pulmonary function test(PFT).The PFT parameters and CT lung function assessment results of each TCM syndrome type of COPD were compared and analyzed for the COPD TCM syndrome differentiation.Methods:According to the TCM diagnosis standard of COPD,the classification,PFT and CT examination were completed,and the three-dimensional reconstruction of CT image was carried out to calculate the pulmonary emphysema pixel index(LAA%).Results:The correlation coefficient between LAA%and FEV1%pred,FEV1/FVC%were-0.775,-0.458,respectively(both P=0.001).There were significant differences among the four syndromes(P<0.01).FEV1%pred and FEV1/FVC%decreased gradually from the syndrome of phlegm stagnation in the lung,the syndrome of phlegm heat accumulation in the lung,the syndrome of phlegm stasis in the lung and the syndrome of lung and kidney qi deficiency.LAA%increased gradually from the syndrome of phlegm stagnation in the lung,the syndrome of phlegm heat accumulation in the lung,the syndrome of phlegm stasis in the lung and the syndrome of lung and kidney qi deficiency.Conclusions:There is a negative correlation between CT pulmonary function assessment and pulmonary function.With the decrease of pulmonary ventilation function,LAA%of COPD patients also increases,which shows that CT evaluation of pulmonary function is feasible.There are differences in emphysema index and pulmonary function parameters between TCM syndromes of COPD,which can provide a certain reference value for syndrome differentiation and classification of COPD.