Early diagnosis of chronic obstructive pulmonary disease based on quantitative parameters of inspiratory and expiratory dual-phase CT
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摘要:
目的 探讨慢性阻塞性肺疾病（COPD）患者呼吸双相CT定量参数特点以及CT定量参数对COPD的早期诊断价值。 方法 回顾性选取2018年3月~2020年12月我院收治的COPD患者112例，对其进行呼吸双相CT扫描和肺功能检查，分别记录患者肺功能指标，包括用力肺活量（FVC）、第1秒用力呼气容积（FEV1%）和第1秒用力呼气容积与肺活量比值（FEV1/FVC），采用FACT-Digital lungTM数据分析软件获取患者CT定量参数呼吸气相肺容积（LV）、平均肺密度（MLD）和肺气肿指数（EI），并检验CT定量参数与肺功能指标的相关性。 结果 COPD患者的FVC为2.95±0.86 L，FEV1%为2.06±0.78 L，FEV1/FVC为（61.76± 11.93）%。COPD患者呼气相的LV小于吸气相，MLD和EI大于吸气相，差异有统计学意义（P < 0.05）。呼气相LV与FVC无相关性（P > 0.05），LV与FEV1%和FEV1/FVC呈负相关关系（P < 0.05），MLD与FVC、FEV1%和FEV1/FVC均呈正相关关系（P < 0.05），EI与FVC、FEV1%和FEV1/FVC均呈负相关关系（P < 0.05）。吸气相LV与FVC呈正相关关系，与FEV1%和FEV1/FVC呈负相关关系（P < 0.05），MLD与FVC呈负相关关系，与FEV1%和FEV1/FVC呈正相关关系（P < 0.05），EI与FVC、FEV1%和FEV1/FVC均呈负相关关系（P < 0.05）。 结论 呼吸双相CT定向参数指标与肺功能指标有较好的相关性，对于COPD早期诊断有较好的指导价值。 Abstract:Objective To explore the characteristics of inspiratory and expiratory dual- phase CT quantitative parameters in patients with chronic obstructive pulmonary disease (COPD) and the early diagnosis value of CT quantitative parameters on COPD. Methods A total of 112 patients with COPD admitted to the hospital were retrospectively selected between March 2018 and December 2020 for inspiratory and expiratory dual-phase CT scan and pulmonary function examination. The pulmonary function indicators such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1%) and ratio of forced expiratory volume in one second to maximum vital capacity (FEV1/FVC) were recorded. FACT-Digital lungTM data analysis software was used to obtain the CT quantitative parameters of lung volume (LV), mean lung density (MLD) and emphysema index (EI) of inspiratory and expiratory phases. The correlation between CT quantitative parameters and pulmonary function indicators was analyzed. Results The FVC, FEV1% and FEV1/FVC of patients with COPD were 2.95 ± 0.86 L, 2.06 ± 0.78 L and (61.76±11.93)%. Among patients with COPD, the LV of expiratory phase was significantly lower than that of inspiratory phase while the MLD and EI were significantly higher than those of inspiratory phase (P < 0.05). The expiratory phase LV was not significantly correlated with FVC (P > 0.05), but LV was significantly negatively correlated with FEV1% and FEV1/FVC (P < 0.05). MLD was significantly positively correlated with FVC, FEV1% and FEV1/FVC (P < 0.05). EI was significantly negatively correlated with FVC, FEV1% and FEV1/FVC (P < 0.05). Inspiratory phase LV was positively correlated with FVC and was negatively correlated with FEV1% and FEV1/FVC (P < 0.05). MLD was negatively correlated with FVC, and positively correlated with FEV1% and FEV1/FVC (P < 0.05), EI was significantly negatively correlated with FVC, FEV1% and FEV1/FVC (P < 0.05). Conclusion There is a good correlation between the quantitative parameters of inspiratory and expiratory dual-phase CT and pulmonary function indicators, which has a good guiding value for the early diagnosis of COPD. -
Key words:
- chronic obstructive /
- pulmonary disease /
- dual-phase CT scan /
- CT quantification /
- diagnosis
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图 1 53岁男性COPD患者的CT图像
A: 肺气肿患者吸气末双肺上叶选取的感兴趣区; B: 肺气肿患者吸气末右肺中叶、左肺上叶舌段选取的感兴趣区; C: 肺气肿患者吸气末双肺下叶选取的感兴趣区.
Figure 1. CT images of a 53-year-old male patient with COPD
表 1 COPD患者一般资料和肺功能指标
Table 1. General data and pulmonary function indicators of patients with COPD
指标 COPD（n=112） 性别（n） 男 87 女 25 年龄（岁, Mean±SD） 51.28±7.49 GOLD分级（n） Ⅰ级 25 Ⅱ级 27 Ⅲ级 31 Ⅳ级 29 FVC（L, Mean±SD） 2.95±0.86 FEV1%（L, Mean±SD） 2.06±0.78 FEV1/FVC（%, Mean±SD） 61.76±11.93 GOLD: 慢性阻塞性肺疾病防治全球倡议; FVC: 用力肺活量; FEV1%: 第1秒用力呼气容积; FEV1/FVC: 第1秒用力呼气容积与肺活量比值. 
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表 2 COPD患者呼、吸相CT定量参数差异
Table 2. Differences in CT quantitative parameters of expiratory and inspiratory phases in patients with COPD (Mean±SD)
参数 呼气相 吸气相 t P LV（mL） 4096.38±923.96 6312.47±1249.63 15.091 < 0.001 MLD（Hu） -801.25±54.61 -876.53±25.32 13.235 < 0.001 EI 48.75±16.85 32.57±11.94 8.292 < 0.001 LV: 肺容积; MLD: 平均肺密度; EI: 肺气肿指数.
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表 3 COPD患者呼气相CT定量参数与肺功能相关性
Table 3. Correlation between CT quantitative parameters of expiratory phase and pulmonary function in patients with COPD
参数 FVC FEV1% FEV1/FVC（%） r P r P r P LV -0.128 0.275 -0.451 < 0.001 -0.372 0.017 MLD 0.379 0.012 0.389 0.012 0.388 0.019 EI -0.401 < 0.001 -0.696 < 0.001 -0.392 < 0.001
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表 4 COPD患者吸气相CT定量参数与肺功能相关性
Table 4. Correlation between CT quantitative parameters of inspiratory phase and pulmonary function in patients with COPD
参数 FVC FEV1% FEV1/FVC（%） r P r P r P LV 0.411 < 0.001 -0.622 < 0.001 -0.465 < 0.001 MLD -0.299 0.045 0.387 0.018 0.362 0.022 EI -0.413 < 0.001 -0.489 < 0.001 -0.407 < 0.001
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