Correlation of CT imaging characteristics of chronic obstructive pulmonary disease and the therapeutic effect of high flow nasal oxygen
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摘要:
目的研究慢性阻塞性肺疾病（COPD）肺部CT影像特点与高流量鼻氧治疗（HFNO）疗效的关系。 方法选择100例COPD疾病加重患者作为研究对象，所有研究对象均在入组本研究后均完善肺部CT检查，评估每例患者的肺部变化特征（包括小叶中心性肺气肿、全小叶性肺气肿、间隔旁肺气肿、间质性肺气肿），并对患者的肺气肿严重程度进行Goddard评分。所有患者均接受HFNO治疗，根据患者治疗前后的血气分析结果进行疗效评定，分析HFNO疗法与COPD患者不同肺部CT影像分类患者疗效的关系。 结果100例COPD患者中，根据肺部CT结果，小叶中心性肺气肿32例、全小叶性肺气肿21例、间隔旁肺气肿20例、间质性肺气肿27例；肺气肿严重程度Goddard评分下：0分0例，1分23例，2分32例，3分33例，4分12例；HFNO治疗在各种肺气肿类型患者中的有效率分别为75.00%、66.67%、85.00%、25.93%，组间有效率差异有统计学意义（χ2=21.894，P < 0.001），小叶中心性肺气肿、全小叶性肺气肿、间隔旁肺气肿患者间有效率差异无统计学意义（χ2=1.857，P=0.395）；HFNO治疗在不同肺气肿严重程度Goddard评分患者中的有效率分别为：95.65%、90.63%、30.30%、8.33%，组间有效率差异有统计学意义（χ2=50.927，P < 0.001）。Goddard评分1分、2分患者的有效率差异无统计学意义（χ2=0.501，P=0.632），Goddard评分3分和4分患者间有效率差异无统计学意义（χ2=2.620，P=0.141）。 结论HFNO治疗COPD患者时，适用于小叶中心性肺气肿、全小叶性肺气肿、间隔旁肺气肿患者，以及Goddard评分为1分、2分的患者，1 h内疗效较为满意，对间质性肺气肿及Goddard评分3分以上的患者疗效欠佳。 Abstract:ObjectiveTo explore the correlation of high flow nasal oxygen (HFNO) therapy and pulmonary CT imaging classification in patients with chronic obstructive pulmonary disease (COPD). MethodsA total of 100 patients with COPD disease worsen were selected as the research object. ALL patients were given lung CT examination, assessment of each patient's lung characteristics (including lobular centricity emphysema, whole panlobular emphysema, next to the interval emphysema and interstitial emphysema). the severity of patients with emphysema Goddard were conducted. All patients received HFNO treatment, and the efficacy was evaluated according to the results of blood gas analysis before and after treatment. The correlation of HFNO treatment and the efficacy of COPD patients with different lung CT image classification was analyzed. ResultsAmong the 100 patients with COPD, 32 were central lobular emphysema, 21 were total lobular emphysema, 20 were septal emphysema and 27 were interstitial emphysema. The Goddard score for the severity of emphysema: 0 score with 0 cases, 1 score with 23 cases, 2 score with 32 cases, 3 score with 22 cases, 4 score with 12 cases. The effective rates of high flow nasal oxygen treatment in patients with various types of emphysema were 75.00%, 66.67%, 85.00% and 25.93%, respectively, with a significant difference of effective rate between the groups (χ2=21.894, P < 0.001). There was no significant difference of the effective rate among patients with central lobular emphysema, total lobular emphysema and parietal emphysema (χ2=1.857, P=0.395). The effective rates of high- flow nasal oxygen treatment in patients with different Goddard scores of emphysema severity were 95.65%, 90.63%, 30.30% and 8.33%, respectively (χ2=50.927, P < 0.001). There was no significant difference in the response rates of patients with Goddard scores of 1 and 2 (χ2=0.501, P=0.632). The difference of the response rates between patients with Goddard scores of 3 and 4 was not significant (χ2=2.620, P=0.141). ConclusionHFNO treatment is suitable for the COPD patients in those central lobular emphysema, total lobular emphysema, parietal emphysema, and the patients with the Goddard score of 1 and 2. The curative effect is satisfactory within 1 hour. The curative effect is worse for the patients with the interstitial emphysema and the Goddard score of more than 3. -
图 1 不同类型肺气肿的肺部CT影像
A:小叶中心性肺气肿, 可见条索状的小叶内的动脉（红色箭头）, 周围可见大量充气扩张的远端气道（黄色箭头）; B:全小叶性肺气肿, 肺实质密度广泛性减低，可见病变肺血管与小叶中心性肺气肿并存并融合（红色箭头）; C:间隔旁肺气肿, 胸膜下和支气管血管旁的低密度区，被小叶间隔分隔, 可伴有肺大泡（红色箭头）; D:间质性肺气肿, 气肿气体位于肺间质内（红色箭头）, 可见血管周围透亮影或者低密度晕征和小囊肿（黄色箭头）
Figure 1. Lung CT images of different types of emphysema.
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