小气道三维CT定量参数对慢性阻塞性肺疾病评估价值的研究

Assessment of small airway three-dimensional CT quantitative parameters in patients with COPD

目的探讨三维CT定量测量小气道参数与肺功能相关性在慢性阻塞性肺疾病(COPD)患者评估中的价值。方法回顾性纳入2020年1月至2021年3月于安徽医科大学第一附属医院和六安世立医院呼吸与危重症医学科就诊的146例急性加重期COPD患者,根据慢性阻塞性肺疾病全球倡议(GOLD)分级标准将患者分为GOLD1~2级(62例)、GOLD3~4级(84例),收集患者胸部CT、肺功能、临床评分和6 min步行距离等资料。定量测量患者肺气肿指数(LAA%_(-950HU)),肺动脉与主动脉比值(PA∶A)以及第3~8级气道参数壁面积百分比(WA%)、壁厚外径比(TDR)。结果GOLD3~4级患者WA%_(7~8)、TDR_(7~8)、全肺LAA%_(-950HU)均高于GOLD1~2级(P<0.001);小气道定量参数WA%_(7~8)、TDR_(7~8)与一秒率(FEV_(1)/FVC)、第一秒用力呼气容积占预计值百分比(FEV_(1)%pre)、用力呼气50%时的瞬间流速(FEF_(50%))、用力呼气75%时的瞬间流速(FEF_(75%))均负相关(P<0.001),且相关性均高于大气道;每一肺叶LAA%_(-950HU)与肺功能均负相关,且双肺下叶相关性最大;多元回归分析显示TDR_(7~8)和全肺LAA%_(-950HU)可共同预测患者肺功能FEV_(1)/FVC、FEV_(1)%pre下降(P<0.001)。结论利用CT三维重建定量小气道参数,发现小气道WA%、TDR可较好预测COPD患者肺功能,对COPD的评估有一定价值。

Objective To explore the clinical value of the correlation between three-dimensional CT quantitative small airway parameters and pulmonary function in patients with chronic obstructive pulmonary disease(COPD).Methods In this retrospective study,totally 146 patients with acute exacerbation of COPD were included,who underwent chest CT and completed pulmonary function tests,questionnaires,and the 6-minute walk test in the Department of Respiratory and Critical Care Medicine at the First Affiliated Hospital of Anhui Medical University and Lu'an Shili Hospital from January 2020 and March 2021.Patients were divided into GOLD1-2(62 cases)and GOLD3-4(84 cases)grade by Global initiative for chronic Obstructive Lung Disease(GOLD)criteria.The data of the above examinations were collected.The percentage of emphysema(LAA%_(-950HU)),the ratio of pulmonary artery to aorta(PA∶A)and airway dimensions from the third to the the eighth generations of bronchi(WA%)and TDR were quantitatively analyzed.Results WA%_(7~8),TDR_(7~8) and whole lung LAA%_(-950HU) were significantly higher in patients with GOLD3~4 than those with GOLD1~2(P<0.001).WA%_(7~8) and TDR_(7~8)were negatively correlated with FEV_(1)/FVC,FEV_(1)%pre,FEF_(50%) and FEF_(75%)(P<0.001),and the correlation coefficient of small airway parameters was higher than that of large airway.LAA%_(-950HU) in each lobe was negatively correlated with lung function,especially in the lower lobe.Multiple regression analysis showed that TDR_(7~8) and whole lung LAA%_(-950HU) could predict the decline of FEV_(1)/FVC and FEV_(1)%pre(P<0.001).Conclusion It is found through reconstruction of small airway quantitative parameters by 3D CT that WA%and TDR of small airway can better predict the pulmonary function in COPD patients,which is valuable for the evaluation of COPD.