慢性阻塞性肺疾病合并支气管扩张患者的MSCT与肺功能的相关性研究

摘要

目的 探讨慢性阻塞性肺疾病(COPD)合并支气管扩张患者的多层螺旋CT(MSCT)肺容积指标与常规肺功能的相关性.方法 选取2015年1月～2016年12月上海市嘉定区中心医院呼吸内科COPD住院患者104例,按照是否合并支气管扩张将其分为两组,单纯COPD组(56例)和COPD合并支气管扩张组(48例).两组患者MSCT肺容积指标和常规肺功能指标进行比较并分析二者的相关性.结果 COPD合并支气管扩张组较单纯COPD组第1秒用力肺活量占预计值百分比(FEV1％pred)、第1秒用力呼气量占用力肺活量比值(FEV1/FVC)、用力肺活量占预计值百分比(FVC％pred)、一氧化碳弥散量占预计值百分比(DLCO％pred)明显低于单纯COPD组,残气量与肺总量的比值(RV/TLC)明显高于单纯COPD组(P＜0.05).COPD合并支气管扩张组MSCT肺容积指标深吸气末全肺容积(Vin)、深呼气末全肺容积(Vex)、容积比(Vex/Vin)均明显高于单纯COPD组,容积差(Vin-Vex)明显低于单纯COPD组(P＜0.05).COPD合并支气管扩张组MSCT肺容积指标Vin与肺功能指标FEV1、FEV1/FVC呈负相关(r＜0,P＜0.05),与肺功能指标RV、TLC、RV/TLC呈正相关(r＞0,P＜0.05);Vex与肺功能指标FEV1、FEV1/FVC、TLC、RV/TLC呈负相关(r＜0,P＜0.05),与肺功能指标RV呈正相关(r＞0,P＜0.05);Vex/Vin与肺功能指标FEV1、TLC、RV/TLC呈负相关(r＜0,P＜0.05),Vex/Vin与肺功能指标RV呈正相关(r＞0,P＜0.05);Vin-Vex/Vin与肺功能指标FEV1、FEV/FVC、RV、TLC、RV/TLC呈正相关(r＞0,P＜0.05).结论 COPD患者合并支气管扩张时,肺功能下降更为明显,且提示病情较为严重;MSCT可明确COPD合并支气管扩张患者肺功能及支气管结构的变化,在疾病诊治及预后评估方面具有重要的意义.%Objective To explore the correlation between lung volume index of multi-slice spiral CT (MSCT) and routine pulmonary function of patients suffering from chronic obstructive pulmonary disease (COPD) combined with bronchiectasis.Methods From January 2015 to December 2016,a total of 104 hospitalized patients in Department of Respiration,Shanghai Jiading District Central Hospital were selected and divided into COPD group (56 cases) and COPD combined with bronchiectasis (48 cases) by whether combined with bronchiectasis.The lung volume indexes of MSCT and routine pulmonary function were compared between the two groups.The correlation of lung volume indexes of MSCT and routine pulmonary function in the group of COPD combined with bronchiectasis were analyzed.Results FEV1％pred,FEV1/FVC,FVC％pred,DLCO％pred in the COPD combined with bronchiectasis group were lower than those of COPD group,and RV/TLC was significantly higher than that of COPD group (P ＜ 0.01).The lung volume indexes of inspiratory volume (Vin),expiratory volume (Vex),Vex/Vin in the COPD combined with bronchiectasis group were all higher than those of COPD group (P ＜ 0.05),and the Vin-Vex was much lower than that of COPD group (P ＜ 0.05).The lung volume indexes of Vin in the COPD combined with bronchiectasis group in MSCT was negatively correlated with the lung volume indexes of FEV1 and FEV1/FVC(r ＜ 0,P ＜ 0.05),and the Vin was positively correlated with the lung volume indexes of RV,TLC and RV/TLC (r ＞ 0,P ＜ 0.05).Vex was negatively correlated with the lung volume indexes of FEV1,FEV1/FVC,TLC and RV/TLC (r ＜ 0,P ＜ 0.05),Vex was positively correlated with RV(r ＞ 0,P ＜ 0.05);Vex/Vin was negatively correlated with FEV1,TLC and RV/TLC (r ＜ 0,P ＜ 0.05);and was positivily correlated with RV.Vin-Vex/Vin was positively correlated with FEV1,FEV1/FVC,RV,TLC and RV/TLC (r ＞ 0,P ＜ 0.05).Conclusion The pulmonary function of COPD patients combined with bronchiectasis declined more apparently and indicates the condition is more serious.The pulmonary function and changes in the bronchi structure of COPD patients combined with bronchiectasis can be clarified by MSCT and it has great significance for the diagnostic,treatment and prognostic evaluation.