CT影像学评估对慢阻肺急性加重频繁住院的预测能力探讨

Predictive ability of CT imaging for frequent hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨CT影像学评估对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者频繁住院情况的预测能力。方法回顾性分析中国科学技术大学附属第一医院2019年6月至2021年3月确诊为慢性阻塞性肺疾病急性加重期的患者的临床资料。调取患者的肺部CT图像,利用Thoracic VCAR软件对纳入的数据进行定量CT分析研究。得到肺气肿的测量值[CT值小于-950的HU低密度衰减区占两肺体积百分比(%LAA)]以及气道指标测量值[壁面积百分比(WA%)和气道壁厚度与管径的比值(WT/D)]。调查患者前一年因慢性阻塞性肺疾病急性加重而住院的次数。根据患者过去一年住院的情况进行分组,分析导致急性加重住院的因素以及预测频繁急性加重住院的因素。结果与有急性加重但未住院的患者相比,因急性加重而住院的患者肺气肿及气道病变有显著差异(P<0.001)。住院患者肺气肿参数%LAA及气道指标WA%、WT/D均较高。Logistic回归分析表明,%LAA≥10%与频繁住院独立相关。结论定量CT肺气肿及气道指标均有助于预测AECOPD患者的住院情况。在频繁住院患者中,肺气肿相较于气道病变更具备预测能力。

Objective To investigate the predictive ability of CT evaluations for frequent hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Linical data of patients diagnosed with AECOPD in the First Affiliated Hospital of USTC from June 2019 to March 2021 were retrospectively analyzed.Multi-slice spiral CT images of the patients were collected,and Thoracic VCAR software was used to conduct quantitative CT analysis of the included data.Emphysema measurements[a percentage of lung attenuation less than 950 Hounsfield units(%LAA)]and airway indicators[wall area percentage(%WA) and ratio of airway wall thickness to total diameter(WT/D)]were collected.The frequency of hospitalizations for patients with AECOPD in the previous year was investigated.Patients were grouped according to their hospitalizations in the past year to analyze factors leading to acute exacerbations and to predict factors contributing to frequent acute exacerbations.Results Compared with patients with acute exacerbation but not hospitalized,patients hospitalized for acute exacerbation had significant differences in emphysema and airway lesions(P<0.001).The emphysema parameters%LAA,airway index%WA,and WT/D were higher in hospitalized patients.Logistic regression analysis showed that%LAA≥10%was independently associated with frequent hospitalizations.Conclusion Quantitative CT emphysema and airway indicators are both helpful in predicting hospitalization in AECOPD patients.Emphysema is more predictive than airway disease in frequently hospitalized patients.