右肺上叶尖段及其亚段支气管CT定量参数对慢性阻塞性肺疾病病情的评估价值

摘要

Objective To evaluate the application value of quantitative CT in the apical segmental and sub -segmental bronchi of right upper lobe for assessment of acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Thirty-one cases of COPD patients in acute exacerbation period and remission period with complete clinical data were selected.The airway wall thickness(WT),airway diameter ratio(TDR),airway wall area(WA)and the percentage of airway wall area accounting for the total cross-sectional area(WA%)of the apical segmental and sub-segmental bronchi of the right upper lobe were measured and calculated by multi-slice spiral CT(MSCT)on the same COPD patient in acute exacerbation period and remission period.The relationship between the four parameters and pulmonary function indexes (FEV1%and FEV1/FVC)was analyzed.Results TDR of the apical segmental bronchi of right upper lobe in the COPD patients in the acute exacerbation period was greater than that in the remission period(P<0.05), and WT,TDR, WA, WA%of the sub-segmental bronchi of the right upper lobe were greater than those in the remission period(P<0.05 or P<0.01).There was no correlation between WA %,WA,TDR,WT and FEV1%,FEV1/FVC in the apical segmental bron-chi of right upper lobe of patients in the acute exacerbation period and remission period(all P>0.05).In the sub-segmental bronchi of right upper lobe of patients,WA%was negatively correlated with FEV 1%(r=-0.425, -0.400,P<0.05), and TDR was negatively correlated with FEV 1%(r=-0.517, -0.473, both P<0.05).Conclusion Quantitative CT shows that the stenosis and wall thickening degree in the sub-segmental bronchi of right upper lobe are significantly higher than those in apical segmental bronchi of COPD patients in acute exacerbation period,and quantitative CT measurement could be helpful to identify COPD patients with acute exacerbation.%目的 探讨右肺上叶尖段及其亚段CT定量参数在慢性阻塞性肺疾病(简称慢阻肺)病情评估中的价值.方法 选取临床资料完整、经历急性加重期及缓解期的慢阻肺患者31例.同一患者分别于急性加重期及缓解期行多排螺旋CT检查,检测右肺上叶尖段及其亚段支气管的气道壁厚度(WT)、气道外径比(TDR)、气道壁面积(WA)及气道壁面积占总横截面积的百分比(WA%),分析CT定量参数与肺功能指标FEV1%、FEV1/FVC的关系.结果 慢阻肺患者急性加重期右肺上叶尖段TDR大于缓解期(P<0.05),右肺上叶尖段亚段支气管WT、TDR、WA、WA%均较缓解期增加(P<0.05或<0.01).慢阻肺患者急性加重期及缓解期右肺上叶尖段支气管WA%、WA、TDR、WT与FEV1%、FEV1/FVC之间均无相关性(P均>0.05);右肺上叶尖段亚段支气管WA%均与FEV1%呈负相关(r分别为-0.425、-0.400,P均<0.05),TDR均与FEV1%呈负相关(r分别为-0.517、-0.473,P均<0.05).结论 慢阻肺急性加重期患者CT定量显示右肺上叶尖段亚段支气管管腔狭窄程度与管壁增厚程度均较段支气管明显;CT定量参数变化有助于发现可能发生急性加重的慢阻肺.