低剂量CT筛查人群中胸部参数响应图与肺功能的相关性分析

Correlation analysis between chest parameter response mapping and lung function in low-dose computed tomography screening population

目的分析基于低剂量CT筛查社区人群中胸部参数响应图(PRM)与肺功能指标第1秒用力呼气容积(FEV_(1))的相关性。方法回顾性纳入2018年8月至2021年7月在我院进行低剂量CT筛查的2428例受试者。根据肺气肿指数(EI)将受试者分为无肺气肿组(EI<6%,n=1992)和肺气肿组(EI≥6%,n=436),进一步依据有无吸烟史分为无肺气肿不吸烟组(n=1033)、无肺气肿吸烟组(n=307)、肺气肿不吸烟组(n=203)和肺气肿吸烟组(n=165)。通过薄层CT后处理获得受试者的PRM参数,包括全肺总体积、肺气肿体积、功能小气道病变体积、正常肺组织体积及后3个指标分别占全肺总体积的百分比;右肺总体积、肺气肿体积、功能小气道病变体积、正常肺组织体积及后3个指标分别占右肺总体积的百分比;左肺总体积、肺气肿体积、功能小气道病变体积、正常肺组织体积及后3个指标分别占左肺总体积的百分比。分析有肺气肿组和无肺气肿组年龄、性别、BMI、吸烟史、FEV_(1)、PRM参数等的差异,以及无肺气肿不吸烟组、无肺气肿吸烟组、肺气肿不吸烟组、肺气肿吸烟组受试者中PRM参数与FEV_(1)的相关性。结果肺气肿组年龄、男性患者占比、FEV_(1)高于无肺气肿组,BMI低于无肺气肿组(P均<0.05)。肺气肿组与无肿气肿组PRM参数比较显示,肺气肿组受试者全肺、右肺、左肺的正常肺组织体积分别占全肺、右肺、左肺总体积的百分比均小于无肺气肿组(P均<0.001),其他指标均大于无肺气肿组(P均<0.001)。在肺气肿吸烟组受试者中,全肺、右肺、左肺的正常肺组织体积及其占总体积的百分比均与FEV_(1)呈弱至中度正相关(r_(s)=0.258~0.482,P均<0.001),全肺、右肺、左肺的肺气肿体积和功能小气道病变体积及其占总体积的百分比均与FEV_(1)呈弱至中度负相关(r_(s)=-0.368~-0.189,P均<0.05)。结论PRM参数在有、无肺气肿人群中存在差异。在有肺气肿且吸烟的人群中,PRM参数与FEV_(1)存在不同程度的相关性,有望成为筛查气流受限高危人群的预警标志物。

Objective To analyze the correlation between chest parameter response mapping(PRM)and forced expiratory volume in one second(FEV_(1))in community population based on low dose-computed tomography(CT)screening.Methods A total of 2428 subjects who underwent low-dose CT screening in our hospital from Aug.2018 to Jul.2021 were retrospectively enrolled.According to the emphysema index(EI),they were divided into non-emphysema group(EI<6%,n=1992)and emphysema group(EI≥6%,n=436),and further divided into non-emphysema+non-smoking group(n=1033),non-emphysema+smoking group(n=307),emphysema+non-smoking group(n=203),and emphysema+smoking group(n=165)according to their smoking history.The PRM parameters of the subjects were obtained through thin-layer CT post-processing,including whole lung volume,emphysema volume,functional small airway disease volume,normal lung tissue volume,and the percentage of the latter 3 indicators in whole lung volume;total right lung volume,emphysema volume,functional small airway disease volume,normal lung tissue volume,and the percentage of the latter 3 indicators in total right lung volume;and total left lung volume,emphysema volume,functional small airway disease volume,normal lung tissue volume and the latter 3 indicators accounted for the percentage of the total left lung volume,respectively.The differences of the age,gender,body mass index(BMI),smoking history,FEV_(1)and PRM parameters between the groups with or without emphysema and the correlation between the PRM parameters and FEV_(1)between the 4 groups were analyzed.Results The age of subjects,the proportion of male patients and FEV_(1)in the emphysema group were higher than those in the non-emphysema group,while the BMI was lower than those in the non-emphysema group(all P<0.05).The comparison of PRM parameters between the emphysema group and the non-emphysema group showed that the percentages of normal lung tissue volume in the volume of the whole lung,right and left lung in the emphysema group were smaller than those in the non-emphysema group(all P<0.001),while the other indexes were larger than those in the non-emphysema group(all P<0.001).In the emphysema+smoking group,the normal lung tissue volumes of the whole lung,right and left lung and their percentages in the total volume were weakly to moderately positively correlated with FEV_(1)(r_(s)=0.258-0.482,all P<0.001).The volumes of emphysema and functional small airway disease of the whole lung,right and left lung as well as the percentages of the above 2 indicators in the total volume of the whole lung,right lung and left lung,respectively,were weakly to moderately negatively correlated with FEV_(1)(r_(s)=-0.368--0.189,all P<0.05).Conclusion PRM parameters are different in population with or without emphysema.In population with emphysema and smoking,PRM parameters have varying degrees of correlation with FEV_(1).PRM is expected to become an early warning marker for screening high-risk groups with airflow limitation.