基于双气相CT扫描肺血管定量参数对慢性阻塞性肺疾病及高危人群的诊断价值研究

Diagnostic value study of pulmonary vascular quantitative parameters in patients with chronic obstructive pulmonary disease and high-risk group based on biphasic CT scan

目的探讨双气相CT肺血管定量参数的差值、相对值在慢性阻塞性肺疾病(COPD)诊断及高危人群预警中的价值。方法该研究为横断面研究。回顾分析2018年8月至2020年12月在海军军医大学第二附属医院接受双气相胸部CT检查的受试者624例,根据肺功能检查进行分组:正常组321例、保留比率的肺功能受损(PRISm)组204例及COPD组99例。双气相CT图像导入工作站得到肺血管定量参数:呼气相、吸气相全肺距胸膜9、12、15、18、21 mm水平的肺血管数量(N_(total))、横截面积小于5 mm2肺小血管数量(N_(CSA5))、血管面积(VA_(total))及全肺血管总体积(TBV)、全肺横截面积<5 mm2的肺小血管体积(BV5),并计算呼气相与吸气相差值、呼气相与吸气相相对值。使用ANOVA检验或Kruskal-WallisH检验比较3组肺血管定量参数的差异,两两比较时采用LSD或Bonferroni检验。结果正常组、PRISm组及COPD组中吸气相全肺距离胸膜9、12、15、18、21 mm水平的N_(total)、N_(CSA5)、VA_(total)及TBV、BV5整体呈现先减少后增多的趋势,PRISm组低于正常组(P<0.05)。COPD组与正常组在距离胸膜9、21 mm水平N_(total)、N_(CSA5)、VA_(total)的差异无统计学意义(P>0.05),而呼气相与吸气相差值、呼气相与吸气相相对值在COPD组与正常组的差异有统计学意义(P<0.05)。结论双气相CT肺血管定量参数差值、相对值比单一吸气相血管参数更有助于区分COPD患者与正常人群的肺血管重塑变化,同时也补充PRISm人群的肺血管特征,为COPD及高危人群的早期预警提供依据。

Objective To explore the value of difference value and relative value of pulmonary vascular quantitative parameters of biphasic CT in diagnosis of chronic obstructive pulmonary disease(COPD)and high-risk groups.Methods The study was a cross-sectional study.A retrospective study of 624 patients who underwent biphasic chest CT scanning in the Second Affiliated Hospital of PLA Naval Medical University from August 2018 to December 2020.Subjects were divided into three groups according to pulmonary function test:normal group(n=321),preserved ratio impaired spirometry(PRISm)(n=204)and COPD group(n=99).The pulmonary vascular quantitative parameters were obtained by the workstation,including the number of pulmonary vessels(N_(total)),cross-sectional area less than that of 5 mm2(N_(CSA5)),vessel area(VA_(total))of 9,12,15,18,21 mm from the pleura,_(total) blood vessels volume(TBV)and _(total) blood vessels volume under 5 mm2(BV5)at expiratory and inspiratory phase.The difference value,relative value of biphasic CT were calculated.ANOVA test or Kruskal-Wallis H test was used to compare the differences of pulmonary vascular quantitative parameters among the three groups,and LSD or Bonferroni tests were used for multiple comparisons.Results The N_(total),N_(CSA5),VA_(total) of the whole lung in the inspiratory phase at the level of 9,12,15,18 and 21 mm from the pleura and TBV,BV5 in the normal group,PRISm group and COPD group,showed an overall trend of decreasing and then increasing,and the PRISm group was lower than those of the normal group(P<0.05).The differences in N_(total),N_(CSA5),VA_(total) between the COPD group and the normal group at the level of 9 and 21 mm from the pleura were not statistically significant(P>0.05),while the N_(total),N_(CSA5),VA_(total) of biphasic difference value and relative value in COPD group demonstrated a significant difference from those in normal group(P<0.05).Conclusion The difference value and relative value of pulmonary vascular quantitative parameters in biphasic CT are more useful than single inspiratory-phase vascular parameters to differentiate the changes in pulmonary vascular remodeling between COPD patients and the normal population,and also to complement the pulmonary vascular characteristics of the PRISm population,which can provide a basis for early warning of COPD and high-risk populations.