数字肺三维成像技术联合肺功能在早期慢性阻塞性肺疾病筛查中的价值

The clinical value of the digital lung three-dimensional imaging technology combined with pulmonary fiunction in the screening of early chronic obstructive pulmonary disease

目的探讨数字肺三维成像(DL3DI)技术联合肺功能检查(PFT)在慢性阻塞性肺疾病(COPD)早期诊断中的应用价值。方法选取2018年1月至2020年12月兰溪市人民医院PFT患者156例,将一秒率>70%且最大呼气中期流量(MMEF)、用力呼出50%及75%肺活量时的瞬间呼气流量(FEF50%、FEF75%)中任意2项<65%预计值的小气道气流受阻的患者100例为观察组;无气流受阻且一秒率>70%的患者56例为对照组。所有患者均作呼吸双相CT扫描,应用DL3DI技术计算出各项参数:肺气肿区(PRM Emph)、小气道病变区(PRM fSAD)、低于-950HU的低密度衰减区(LAA 950%)、肺容积(PV)等参数。结果观察组一秒率、FEV_(1)、FEV%、MEF25-75、PEF指标低于对照组(P<0.001);观察组肺一氧化碳弥散量大于对照组(P<0.001)。在DL3DI技术参数中,观察组PV、PRM Emph、PRM fSAD和LAA950%高于对照组(P<0.001);两组患者在第5、6、7级支气管中的管壁厚度、壁厚直径比、管壁面积比、管腔直径、管腔面积差异均有统计学意义(P<0.001)。相关性分析显示,第7级支气管管壁面积比、PRM fSAD和壁厚直径比与PFT各指标均呈负相关,管腔面积与PFT各指标均呈正相关(P<0.001)。结论DL3DI技术能反映小气道功能的改变,联合PFT对COPD患者早期筛查具有重要临床价值。

Obstructive To explore the clinical value of the digital three-dimensional lung imaging combined with pulmonary function in the screening of early chronic obstructive pulmonary disease(COPD).Methods 156 patients visited the department of respiratory and critical medicine of Lanxi People's Hospital during January 2018 to December 2020 were selected.According to the results of pulmonary function test(PFT),100 patients with small airway airflow restriction were considered as the case group whose forced expiratory volume in the first second accounting for forced vital capacity(FEV_(1)FVC)>70%and any 2 items of maximum mid-expiratory flow(MMEF)and instantaneous expiratory flow<65%of the prediction value.56 patients with FEV_(1)/FVC was>70%and without airflow restriction were considered as the control group.Thetwo groups of patients completed CT respiratory biphasic scanning within one week.The measurement indexes including emphysema area(PRM Emph),small airway lesion area(PRM fSAD),low-density attenuation area lower than-950 HU(LAA950%)and pulmonary volume(PV)of DL3DI were calculated.Results The PFT measurement indexes FEV_(1),FEV%,FEV/FVC,MEF25-75,and PEF in the case group were significantly lower than those in the other group(P<0.001),while the DLCO in the case group was higher than that in the other group(P<0.001).Among the case group,PRM FSAD,PRM EMPH,LV and LAA950%were statistically higher than those of the other group(P<0.001).There were obvious differences between the two groups in the measurement of wall thickness,lumen diameter,wall thickness diameter ratio,wall area percentage and lumen area among grade 5.6 and 7 bronchial.The results of correlation analysis showed that wall area percentage,PRM fSAD and wall thickness diameter ratio were negatively correlated with PFT.The lumen area were positively correlated with PFT(P<0.001).Conclusion The digital three-dimensional lung imaging can sensitively reflect the changes of small airway function,and its combination withPFT has important clinical valuefor the early screeningofCOPD patients.