高分辨率计算机断层扫描对慢性阻塞性肺疾病的定量评估及急性加重风险预测

Quantitative Evaluation of Chronic Obstructive Pulmonary Disease and Risk Prediction of Acute Exacerbation by High-Resolution Computed Tomography.

作者信息

Hua Qifeng, Chen Guoping, Yang Yin, Leng Shaoyi, Zhao Zhenzhen, Bai Feng, Hu Xiaowei, Qiu Liyan, Yu Zhe, Zhang Hongbin, Shi Jiapei, Dai Qi

机构信息

Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.

Department of Respiratory Medicine, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.

出版信息

Evid Based Complement Alternat Med. 2022 Jul 12;2022:6015766. doi: 10.1155/2022/6015766. eCollection 2022.

DOI:10.1155/2022/6015766

PMID:35865341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9296276/

Abstract

OBJECTIVE

It is imperative to popularize the tertiary prevention of chronic obstructive pulmonary disease (COPD) and to improve the diagnosis and treatment.

METHODS

COPD patients were divided into mild ( = 18), moderate ( = 20), severe ( = 24), and extremely severe ( = 22) groups for performing high-resolution computed tomography (HRCT) and pulmonary function test. Serum procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) were detected, and the occurrence rate of acute exacerbation COPD (AECOPD) was recorded during a 12-months follow-up period.

RESULTS

With an increase in the severity grade, the HRCT indexes, including emphysema index (EI), 1st and 15th percentile of inspiratory attenuation distribution (Perc1 and Perc15), ratio of expiratory/inspiratory mean lung density (MLD) and lung volume (LV), and ratio of the wall thickness to the outer diameter of the lumen (TDR), as well as percentage of the wall area to the total cross-sectional area (WA%) were increased with a decreased change in relative lung volume with attenuation values between -860 and -950 HU (RVC) and lumen area ( ). These were correlated with the ratio of forced expiratory volume in 1 sec (FEV1) over forced vital capacity (FVC) (FEV1/FVC), the percentage of FEV1 the predicted value (FEV1%), and ratio of residual volume to total lung volume (RV/TLC). Body mass index, MLD, FEV1%, FEV1/FVC, and PCT had a predictive value to AECOPD, with the combined AUC of 0.812.

CONCLUSIONS

HRCT imaging effectively classifies the severity of COPD, which combined with BMI, PFT, and serum PCT can predict the risk of AECOPD.

摘要

目的

普及慢性阻塞性肺疾病（COPD）的三级预防并改善其诊断与治疗势在必行。

方法

将COPD患者分为轻度（n = 18）、中度（n = 20）、重度（n = 24）和极重度（n = 22）组，进行高分辨率计算机断层扫描（HRCT）和肺功能测试。检测血清降钙素原（PCT）和高敏C反应蛋白（hs-CRP），并记录12个月随访期内慢性阻塞性肺疾病急性加重（AECOPD）的发生率。

结果

随着严重程度分级增加，HRCT指标，包括肺气肿指数（EI）、吸气衰减分布的第1和第15百分位数（Perc1和Perc15）、呼气/吸气平均肺密度（MLD）与肺容积（LV）之比、管腔壁厚与外径之比（TDR）以及壁面积占总横截面积的百分比（WA%）均升高，而衰减值在-860至-950 HU之间的相对肺容积变化（RVC）和管腔面积降低。这些指标与第1秒用力呼气容积（FEV1）占用力肺活量（FVC）的比值（FEV1/FVC）、FEV1占预计值的百分比（FEV1%）以及残气量与肺总量之比（RV/TLC）相关。体重指数、MLD、FEV1%、FEV1/FVC和PCT对AECOPD具有预测价值，联合曲线下面积（AUC）为0.812。