摘要
目的探讨胸部定量CT在早期诊断慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)中的应用价值。方法回顾性分析2013年9月20日至2014年5月20日上海市某社区COPD高危人群受访者,以及复旦大学附属中山医院门诊的COPD高危咨询者共138例的临床资料。所有高危者在基线及1年后均行肺功能及胸部CT检查,将胸部CT图像导入定量CT分析软件,收集定量CT数据。根据1年后的随访肺功能结果分为COPD组(n=40)与非COPD组(n=98),比较2组在基线时肺功能、定量CT指标的差别。采用二元logistic回归分析COPD高危者随访1年后发生COPD的预测指标,通过ROC曲线评估logistic回归模型的效能。结果2组基线时性别、体质量指数(BMI)、第1秒用力呼气的容积占预计值的百分比(FEV1%pred)、气道壁面积比值(WA%)、气道总数(TAC)、气道壁厚度(WT)差异无统计学意义。COPD组的气道内周长为10 mm处气管壁面积的平方根[Pi10;3.43(3.30,3.54)vs 3.23(3.15,3.36),P<0.001]、低于﹣950 HU的低衰减区面积百分比(LAA%-950)[2.06(0.32,6.29)vs 0.57(0.25,1.89),P=0.015]均显著高于非COPD组,COPD组平均肺密度(MLD)低于非COPD组[(﹣799.89±35.62)vs(﹣783.60±43.52),P=0.038]。二元logistic回归分析显示,年龄和Pi10是患COPD的影响因素(P<0.05),ROC曲线下面积为0.791(95%CI 0.714~0.868)。结论在肺功能正常的COPD高危人群中,Pi10、LAA%﹣950升高的患者1年后COPD发病率高,提示胸部定量CT的指标如Pi10、LAA%-950有助于临床医生识别早期COPD。
Objective To explore the value of quantitative chest CT in early diagnosis of chronic obstructive pulmonary disease(COPD).Methods The clinical data of 138 cases of COPD high-risk patients in Shanghai community and COPD high-risk respondents in outpatient clinic of Zhongshan Hospital,Fudan University from September 20,2013 to May 20,2014 were retrospectively analyzed.All high-risk participants underwent pulmonary function and chest CT examination at baseline and 1 year later.Chest CT images were imported into quantitative CT analysis software to collect quantitative CT data.These participants were divided into COPD group(n=40)and non-COPD group(n=98)based on their lung functions after 1 year.The differences in baseline lung function and quantitative CT measurements between the two groups were compared.Binary logistic regression was used to analyze the predictors of COPD in high-risk individuals after 1 year of follow-up,and the efficacy of the logistic regression model was evaluated by ROC curve.Results There were no significant differences in gender,body mass index(BMI),the percentage value of forced expiratory volume in 1 second predicted(FEV1%pred),airway wall area ratio(WA%),total airway count(TAC),and airway wall thickness(WT)between the two groups at baseline.Compared to the non-COPD group,the square root of the tracheal wall area at 10 mm from the inner circumference of the airway(Pi10),(3.43[3.30,3.54]vs 3.23[3.15,3.36],P<0.001),and the percentage area of low attenuation regions below﹣950 HU(LAA%﹣950),(2.06[0.32,6.29]vs 0.57[0.25,1.89],P=0.015)were significantly higher in the COPD group.The mean lung density(MLD)in the COPD group was lower than that in the non-COPD group([﹣799.89±35.62]vs[﹣783.60±43.52],P=0.038).Binary logistic regression analysis indicated that age and Pi10 were risk factors for COPD(P<0.05),with an area under the ROC curve of 0.791(95%CI 0.714-0.868).Conclusions In the COPD high-risk population with normal lung function,patients with elevated Pi10 and LAA%﹣950 have a higher i
作者
黄锦贤
侯东妮
谢丛意
陈淑靖
许诺
周亚南
姜红妮
宋元林
HUANG Jinxian;HOU Dongni;XIE Congyi;CHEN Shujing;XU Nuo;ZHOU Yanan;JIANG Hongni;SONG Yuanlin(Department of Pulmonary Medicine,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China;Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中国临床医学》
2024年第2期208-214,共7页
Chinese Journal of Clinical Medicine
基金
国家重点研发计划(2020YFC2003700)
厦门市科技计划指导性项目(3502Z20224ZD1085).
关键词
慢性阻塞性肺疾病
胸部定量CT
肺功能
气道壁厚度
肺密度
chronic obstructive pulmonary disease
quantitative chest CT
lung function
airway wall thickness
lung density
