胸部CT评估慢性阻塞性肺疾病患者竖脊肌萎缩及脂肪浸润程度

Chest CT for evaluating erector spinae muscle atrophy and fat infiltration in patients with chronic obstructive pulmonary disease

目的观察胸部CT评估慢性阻塞性肺疾病(COPD)患者竖脊肌(ESM)萎缩及脂肪浸润程度的价值。方法纳入113例接受胸部CT平扫及肺功能检查的稳定期COPD男性患者(COPD组)及40名健康男性(对照组);比较组间及COPD组内不同慢性阻塞性肺疾病全球倡议(GOLD)分级患者一般资料、肺功能检查结果及ESM CT参数,并行相关性分析,观察COPD患者ESM萎缩及脂肪浸润特征。结果组间肺活量(VC)、用力VC(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC、残气量(RV)、RV/肺总量(TLC)、一氧化碳弥散量(DLco)、ESM总横截面积(CSA)、肌肉密度、放射性密度比(RDR)、CSA指数、ESM局部体积、面积密度乘积及肺气肿区域占总肺容积百分比(LAA%)差异均有统计学意义(P均<0.05)。COPD组内各GOLD分级COPD患者体质量、体质量指数(BMI)、深吸气量(IC)、VC、FVC、FEV_(1)、FEV_(1)/FVC、TLC、RV/TLC、DLco、ESM总CSA、CSA指数、ESM局部体积、面积密度乘积及LAA%差异均有统计学意义(P均<0.05)。COPD患者ESM局部体积与FEV_(1)呈中度相关(r=0.52,P<0.001)。结论胸部CT可定量评估COPD患者ESM萎缩及脂肪浸润程度;ESM局部体积为最佳评估指标。

Objective To observe the value of chest CT for evaluating erector spinae muscle(ESM)atrophy and fat infiltration in patients with chronic obstructive pulmonary disease(COPD).Methods Totally 113 male patients with stable COPD(COPD group)and 40 healthy males(control group)were enrolled.The general data,pulmonary function examination results and CT parameters of ESM were compared between groups and among COPD patients with different global initiative for chronic obstructive lung disease(GOLD)grades,and the correlations of the above parameters were analyzed.The characteristics of ESM atrophy and fat infiltration in patients with COPD were observed.Results Significant differences of subjects'vital capacity(VC),forced VC(FVC),forced expiratory volume in one second(FEV_(1)),FEV_(1)/FVC,residual volume(RV),RV/total lung capacity(TLC),diffusion capacity of lung for carbon monoxide(DLco),ESM total cross-sectional area(CSA),muscle density,radiographic density ratio(RDR),CSA index,ESM local volume,area density product and the percentage of the low attenuation area(LAA%)were found between groups(all P<0.05).There were significant differences of patients'body mass,body mass index(BMI),inspiratory capacity(IC),VC,FVC,FEV_(1),FEV_(1)/FVC,TLC,RV/TLC,DLco,ESM total CSA,CSA index,ESM local volume,area density product and LAA%among COPD patients with different GOLD grades(all P<0.05).ESM local volume of COPD patient was moderately correlated with FEV_(1)(r=0.52,P<0.001).Conclusion Chest CT could quantitatively evaluate the degree of ESM atrophy and fat infiltration in patients with COPD.ESM local volume was the best evaluation parameter.