[64层螺旋CT三维重建观察慢性阻塞性肺疾病患者膈肌形态学改变]

[The morphological alteration of the diaphragm in patients with chronic obstructive pulmonary disease with three-dimensional reconstruction of 64-slice spiral CT].

作者信息

Tian Yuan, Ma Shao-lin, Zhang Ye-na, Shi Lei, Zhang Wen-qiang, Zhu Xiao-ping

机构信息

Clinical College of Ningxia Medical University, Yinchuan, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2013 Feb;36(2):94-9.

PMID:23537552

Abstract

OBJECTIVE

To study the morphological alteration of the diaphragm with three-dimensional reconstruction in patients with chronic obstructive pulmonary disease (COPD), and to evaluate the relationship between morphological parameters and pulmonary function.

METHODS

Subjects were consecutively recruited in Shanghai East Hospital of Tongji University from July 2010 to April 2011. They were divided into a COPD (30 males) group, including mild (n = 10), moderate (n = 10), and severe/very severe (n = 10), and a control group (20 males); with the age of the subjects ranging from 45 to 80 years old. The subjects were asked to take pulmonary function test. Each subject underwent CT scanning in residual volume (RV) and total lung capacity (TLC) phases. The imaging of CT scanning was used to reconstruct three-dimensional diaphragm with the special computer software. The length of total diaphragm (Ldi), including the part of the zone apposition (Lap) and part of the dome (Ldo) under coronal (C) and sagittal (S) were observed. The surface area of the diaphragm (Adi), surface area (Aap) of the zone of apposition and surface area (Ado) of the dome were measured as well. In addition, the relationship between morphological indexs and pulmonary function were evaluated.

RESULTS

In RV phase, compared with the control, Ldi and Lap were significantly lower in COPD, S-Ldi: (23.3 ± 2.9) cm vs (31.1 ± 4.3) cm (t = 4.12, P < 0.05); S-Lap: (5.4 ± 1.9) cm vs (12.7 ± 2.0) cm, (t = 6.96, P < 0.05); the difference was more obvious in sagittal slices as compared to the coronal slices. The reduction of S-Ldi was more pronounced in the part of S-Lap. In RV phase, Adi and Aap were also significant lower in COPD, Adi: (571 ± 119) cm(2) vs (811 ± 95) cm(2) (t = 4.06, P < 0.05). Aap: (270 ± 99) cm(2) vs (471 ± 61) cm(2) (t = 4.33, P < 0.05). Aap decreased more significantly, and accounted for the most part of reduction of Adi. There was a significant positive correlation between Aap and S-Lap with pulmonary function (r = 0.577 - 0.787, all P < 0.05), especially for Aap (r = 0.787). In TLC phase, only C-Ldi and C-Lap decreased significantly (t = 3.08, t = 2.80 respectively, all P < 0.05).

CONCLUSIONS

The diaphragmatic length and surface area decreased in patients with COPD, which were more pronounced in the part of the zone of apposition and occurred during RV phase. The dimension of the zone of apposition could be a parameter to reflect the severity of the disease.

摘要

目的

通过三维重建研究慢性阻塞性肺疾病（COPD）患者膈肌的形态学改变，并评估形态学参数与肺功能之间的关系。

方法

2010年7月至2011年4月在同济大学附属东方医院连续招募研究对象。将其分为COPD组（30例男性），包括轻度（n = 10）、中度（n = 10）和重度/极重度（n = 10），以及对照组（20例男性）；研究对象年龄在45至80岁之间。要求研究对象进行肺功能测试。每位研究对象在残气量（RV）和肺总量（TLC）阶段进行CT扫描。利用专用计算机软件对CT扫描图像进行三维膈肌重建。观察冠状面（C）和矢状面（S）下总膈肌长度（Ldi），包括贴附区长度（Lap）和膈肌穹窿部长度（Ldo）。测量膈肌表面积（Adi）、贴附区表面积（Aap）和膈肌穹窿部表面积（Ado）。此外，评估形态学指标与肺功能之间的关系。

结果

在RV阶段，与对照组相比，COPD组的Ldi和Lap显著降低，矢状面Ldi：（23.3 ± 2.9）cm对（31.1 ± 4.3）cm（t = 4.12，P < 0.05）；矢状面Lap：（5.4 ± 1.9）cm对（12.7 ± 2.0）cm，（t = 6.96，P < 0.05）；与冠状面相比，矢状面差异更明显。矢状面Ldi的降低在矢状面Lap部分更显著。在RV阶段，COPD组的Adi和Aap也显著降低，Adi：（571 ± 119）cm²对（811 ± 95）cm²（t = 4.06，P < 0.05）。Aap：（270 ± 99）cm²对（471 ± 61）cm²（t = 4.33，P < 0.05）。Aap下降更显著，且占Adi降低的大部分。Aap和矢状面Lap与肺功能之间存在显著正相关（r = 0.577 - 0.787，均P < 0.05），尤其是Aap（r = 0.787）。在TLC阶段，仅冠状面Ldi和冠状面Lap显著降低（分别为t = 3.08，t = 2.80，均P < 0.05）。