基于CT定量评估肺气肿肺叶分布特点与肺功能的相关性
Characteristics of distribution of emphysema and its correlation with pulmonary function test based on CT quantitative measurement

摘要：目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者肺气肿的空间分布特点及其与肺功能参数的相关性。方法 收集COPD患者61例及正常对照91例，均行肺功能及CT定量扫描，按《2018年慢性肺疾病诊断、治疗及预防全球策略》的诊断标准，将COPD患者分为4级。所得图像导入“数字肺”自动检测平台，计算各肺叶低密度区容积百分比(low attenuation areas volume percentage, LAA%)。分析COPD患者肺气肿的空间分布特点及其与肺功能参数的相关性。结果 各个肺叶中除了右肺中叶LAA%和右肺下叶LAA%与DLCO%预计值、RV/TLC无相关性外，其余各肺叶与肺功能各参数均明显相关。双肺上叶LAA%与肺弥散功能(DLCO%预计值)相关性高于双下肺，双肺下叶与肺气流受限的相关性高于双上肺。随着COPD分级增高，肺叶及各肺叶的LAA%在一定程度上逐渐增加。结论 CT定量测量低密度区容积百分比(LAA%)可以反映肺功能受损的严重程度，还可反映不用肺叶的肺气肿程度，在肺减容术的临床评估起到一定临床价值。
ABSTRACT: Objective To investigate the spatial distribution characteristics of emphysema in chronic obstructive pulmonary disease (COPD) patients and its correlation with pulmonary function test (PFT). Methods We recruited 61 patients with COPD and 91 normal subjects to test their lung function and perform CT quantitative scanning. COPD patients were divided into four grades based on the diagnostic criteria of 2018 Global Strategies for Chronic Pulmonary Disease Diagnosis, Treatment and Prevention. Their images were imported into the digital lung test platform for analysis, and the percentage of volume (LAA%) of low density area of each lung lobe was calculated. We analyzed the spatial distribution characteristics of emphysema in COPD patients and its correlation with pulmonary function parameters. Results There was no correlation between LAA% of the middle right lung lobe and LAA% of the lower right lung lobe, DLCO% and RV/TLC. The correlation between LAA% of the upper lobe and lung dispersion function (DLCO%) was higher than that of lower lobe, and the correlation between the lower lobe and pulmonary airflow limitation was higher than that of the upper lobe. With the increase of COPD grade, LAA% of the pulmonary lobe and each pulmonary lobe gradually increased to a certain extent. Conclusion The quantitative measurement of lung volume percentage in low density area (LAA%) by CT canning reflects the severity of lung function damage and the degree of emphysema without lung lobes, which is of certain clinical value for the clinical evaluation of lung volume reduction surgery