CT肺血管定量参数诊断慢性阻塞性肺疾病及高危人群的价值

Value of CT pulmonary vascular quantitative parameters in diagnosis of chronic obstructive pulmonary disease patients and high-risk groups

目的探讨CT肺血管定量参数诊断慢性阻塞性肺疾病(COPD)及高危人群的价值。方法回顾性分析2015年1月至2020年8月在同济大学附属同济医院接受胸部CT检查和肺功能检测的1126例患者的临床及影像资料。根据肺功能将1126例患者分为COPD组(471例)、COPD高危组(454例)、正常对照组(201例)。定量测量所有患者胸部CT的肺血管参数,包括全肺距胸膜9、15、21 mm的肺血管数量(N_(total))、横截面积小于5 mm^(2)肺小血管数量(N_(CSA<5))、肺表面积(LSA)、肺血管数量与肺表面积比值(N_(total)/LSA)、肺血管总面积(VA_(total))以及总肺血管体积(TBV)、血管面积小于5 mm^(2)体积(BV5)及血管面积小于10 mm^(2)的体积(BV10)。使用Kruskal-Wallis H检验比较3组肺血管定量参数差异;采用Spearman相关性分析CT肺血管参数与肺功能的相关性。结果3组间全肺距胸膜9、15、21 mm的N_(total)/LSA总体比较差异有统计学意义(P<0.05)。3组间全肺距胸膜9 mm的N_(CSA<5)、N_(total)总体比较差异具有统计学意义(P<0.05)。3组间全肺距胸膜9 mm的LSA和全肺距胸膜15、21 mm的N_(CSA<5)、N_(total)、LSA、VA_(total)以及TBV、BV5、BV10总体比较差异具有统计学意义(P<0.05)。COPD高危组中,全肺距胸膜9 mm的N_(total)/LSA、VA_(total)与部分肺功能参数呈正相关(r=0.095~0.139,P<0.05);不同胸膜距离下的N_(CSA<5)、N_(total)、LSA、N_(total)/LSA和TBV、BV5、BV10与部分肺功能参数呈负相关(r=-0.110~-0.215,P<0.05)。COPD组中,全肺距胸膜9 mm的N_(CSA<5)、N_(total)与一氧化碳弥散量实测值与预计值的比值呈正相关(r分别为0.105、0.103,P<0.05),除了N_(total)/LSA与肺功能各参数均存呈正相关外(r=0.181~0.324,P<0.05),余肺血管参数与部分肺功能参数呈负相关(r=-0.092~-0.431,P<0.05)。结论胸部CT定量成像可有效评价COPD患者及高危人群的肺血管变化,且肺血管CT定量参数有可能区分COPD及高危人群,为COPD早期诊断及高危人群预判提供新的途径。

Objective To explore the diagnostic value of CT pulmonary vascular quantitative parameters in patients with chronic obstructive pulmonary disease(COPD)and high-risk groups.Methods A retrospective study of 1126 patients who underwent chest CT examination and pulmonary function test in Shanghai Tongji Hospital from January 2015 to August 2020.According to lung function,they were divided into COPD group(471 cases),high-risk group(454 cases),and normal control group(201 cases).Pulmonary vascular parameters on chest CT,including the total number of vessels(N_(total)),the number cross-sectional area of vessels under 5 mm^(2)(N_(CSA<5)),lung surface area(LSA),number of pulmonary blood vessels per unit lung surface area(N_(total)/LSA)and the total area of vessels(VA_(total))at a 9,15,21 mm depth from the pleural surface,and the total blood vessel volume(TBV),blood vessel volume under 5 mm^(2)and 10 mm^(2)(BV5 and BV10)were measured quantitatively.Kruskal-Wallis H test was used to compare the differences of quantitative parameters of pulmonary vascular in the three groups;Spearman rank test was used to analyze the correlation between CT pulmonary vascular parameters and pulmonary function.Results There were significant differences in N_(total)/LSA at a 9,15,21 mm depth from the pleural surface among three groups(P<0.05).There were significant differences in N_(CSA<5),N_(total)at a 9 mm depth from the pleural surface among three groups(P<0.05).There were significant differences in LSA at a 9 mm depth from the pleural surface,N_(CSA<5),N_(total),LSA,VA_(total)at a 15,21 mm depth from the pleural surface and TBV,BV5 and BV10 among three groups(P<0.05).In high-risk group,there were positive correlation between N_(total)/LSA,VA_(total)at a 9 mm depth from the pleural surface and some pulmonary function parameters(r=0.095-0.139,P<0.05).N_(CSA<5),N_(total),LSA,N_(total)/LSA,TBV,BV5 and BV10 at different depth from pleural surface were negatively correlated with some pulmonary function parameters(r=-0.110--0.215,P<0.05).In COPD group,number of vessels at a 9 mm depth from the pleural surface was positively correlated with the diffusion capacity for carbon monoxide of the lung single breath(r=0.105,0.103,P<0.05).In addition to N_(total)/LSA were positively correlated with lung function parameters(r=0.181-0.324,P<0.05),the remaining pulmonary vascular parameters were negatively correlated with some pulmonary function parameters(r=-0.092--0.431,P<0.05).Conclusion Quantitative chest CT imaging are able to effectively evaluate pulmonary vascular changes in COPD patients and high-risk groups,and the quantitative parameters of pulmonary vascular CT may distinguish COPD from high-risk groups,providing a novel means for early diagnosis of COPD and prediction of high-risk groups.