CT肺气肿容积及小阴影密集度与尘肺肺功能相关性的研究

Correlation between Emphysema Volume and Small Shadow Density on CT and the Lung Function in Pneumoconiosis

目的:比较尘肺患者肺气肿程度及肺部小阴影对肺功能的影响。方法:选择2015年至2020年间十堰市太和医院收治的明确诊断尘肺且合并肺气肿的患者96名,进行胸部CT检查及肺功能测定;采用64排螺旋CT(GE Optima CT 680)进行三维容量测量系统定量分析全肺、左右肺、各肺上中下肺野低衰减区容积百分比(LAV%),并根据全肺LAV%将其分为A组:LAV%<15%,B组:LAV%15%~30%,C组:LAV%>30%三组,分析肺气肿分布特点及与肺功能的相关性;将胸片评定小阴影密集度的标准应用于CT中得出CT图像的全肺、左右肺、上中下肺野小阴影密集度(SSD),并分析与肺功能的相关性。结果:全肺SSD与FEV1、TLC、PEF、MEF75%、MEF25%呈负相关,与RV/TLC呈正相关;全肺、左肺、右肺、及上中下肺野LAV%与FEV1、FEV1%、DLCO、PEF、MEF75%、MEF50%、MEF25%呈负相关,与RV、RV/TLC%呈正相关;当LAV%>30%时,即C组LAV%与肺功能FEV1、FEV1%、DLCO、RV/TLC、PEF、MEF75%、MEF50%、MEF25%间的相关性较A组和B组好;肺部小阴影密集度与肺通气功能、容积参数有一定相关性,但与弥散功能相关性较弱。结论:尘肺患者肺气肿程度及小阴影密集度与肺功能均有一定相关性,但肺气肿较小阴影密集度与肺功能相关性更好,且能在一定程度上评估尘肺患者肺损伤程度,值得临床推广应用。

Objective:To compare the influence of emphysema and lung small shadow on the lung function of patients with pneumoconiosis.Methods:We selected 96 patients who were admitted to the Taihe Hospital(Shiyan city)for pneumoconiosis complicated by emphysema between 2015 and 2020.Chest computed tomography(CT)and lung function assessments were performed.The low attenuation volumes(LAV%)of the whole lung;left and right lungs;and upper,middle,and lower lobes of each lung were quantified using 64-slice spiral CT(GE Optima CT680).Based on the LAV%of the whole lung,the patients were divided into groups A(LAV%<15%),B(LAV%:15%–30%),and C(LAV%>30%).The small shadow density(SSD)of the whole lung;left and right lungs;and upper,middle,and lower lung fields was calculated by applying the criteria for evaluating SSD on chest radiographs to CT images.The correlation between SSD and lung function was also analyzed.Results:The SSD of the whole lung was negatively correlated with the forced expiratory volume in the first second(FEV1),total lung capacity(TLC),peak expiratory flow(PEF),maximum expiratory flow after 75%of the forced vital capacity(FVC)has not been exhaled(MEF75%),and maximum expiratory flow after 25%of the FVC has not been exhaled(MEF25%),and it was positively correlated with residual volume(RV)/TLC.LAV%was negatively correlated with FEV1,ratio of FEV to FEV1(FEV1%),carbon monoxide diffusion capacity(DLCO),PEF,MEF75%,maximum expiratory flow after 50%of the FVC has not been exhaled(MEF50%),and MEF25%in the whole lung;left and right lungs;and upper,middle,and lower lung lobes;however,it was positively correlated with RV and RV/TLC%.When LAV%was>30%,the correlation between LAV%and FEV1,FEV1%,DLCO,RV/TLC,PEF,MEF75%,MEF50%,and MEF25%was stronger in group C than in groups A and B.A certain degree of correlation was observed between the SSD in the lungs and the ventilation function and volume parameters;however,the correlation between SSD and the diffusion function was weak.Conclusion:The degree of emphysema and SSD in patients with pneumoconiosis have a certain degree of correlation with the lung function;however,the SSD of emphysema has a relatively better correlation with the lung function.It can be used to evaluate the degree of lung injury in patients with pneumoconiosis to a certain extent and is worthy of clinical application.