基于定量CT对Ⅱ型糖尿病肺损害结构变化的预测价值

Predictive Value of Quantitative CT Based on the Structural Changes of Lung Lesions in Patients with Type 2 Diabetes

目的 通过比较Ⅱ型糖尿病(T2DM)肺部损害患者与T2DM肺功能正常者的CT定量参数与临床肺功能,分析T2DM肺损害患者肺部影像学变化并探讨T2DM肺损害的影像敏感指标。方法 根据肺功能检查结果回顾性搜集96例T2DM肺功能损害患者影像资料,经“数字肺”处理取得CT定量参数,主要包括双肺容积、双肺低于-910 HU及-950 HU的密度衰减区的体积(LAA910、LAA950)占全肺的百分比(LAA910%、LAA950%)、平均密度。另83例肺功能正常的T2DM患者纳入对照组。采用独立样本t检验或Mann-Whitney U检验对两组肺部定量参数进行差异性分析,将组间存在统计学差异的指标行受试者工作特征(ROC)曲线和多因素Logistic逐步回归分析。结果 与正常对照组相比,肺损害组的肺功能参数FVC、FVC%、FEV1、FEV1%及肺部CT定量指标全肺容积、LAA910、LAA950、LAA910%、LAA950%显著降低(P<0.05),平均密度显著增高(P<0.05)。全肺容积最有助于区分T2DM肺损害,并且为T2DM肺损害的保护因素。结论 肺部CT定量参数可定量反映T2DM患者肺损害,全肺容积较大者可有效避免T2DM肺功能的减低。

Objective To compare CT quantitative parameters and clinical pulmonary function in patients with type 2 diabetic pulmonary injury,analyze the imaging changes of type 2 diabetic pulmonary injury,and explore image-sensitive indicators of T2DM pulmonary injury.Methods According to the results of pulmonary function test,the imaging data of 96 patients with type 2 diabetes mellitus(T2DM) with pulmonary function damage were retrospectively collected,and the quantitative parameters of CT were obtained by “digital lung” processing,mainly including double lung volume,the volume(LAA910,LAA950) of the density attenuation area below-910 HU and-950 HU in both lungs as a percentage of the whole lung(LAA910%,LAA950%),the average density,and another 83 T2DM patients with normal lung function were included in the control group.The independent samples t test or Mann-Whitney U test were used to analyze the differences of the quantitative parameters of the lungs between the two groups.Results Compared with the normal control group,the pulmonary function parameters FVC,FVC%,FEV1,FEV1% and the pulmonary CT quantitative indicators of total lung volume,LAA910,LAA950,LAA910%,and LAA950% in the lung damage group were significantly decreased(P<0.05).The mean density was significantly higher(P<0.05).Whole lung volume is most helpful in distinguishing T2DM lung damage and is a protective factor for T2DM lung damage.Conclusion The quantitative parameters of pulmonary CT can quantitatively reflect the lung damage in patients with T2DM,and those with larger whole lung volume can effectively avoid the reduction of pulmonary function in T2DM.