COPD 患者肺内血管容积与肺气肿及小气道功能障碍的相关性。
Contributions of Emphysema and Functional Small Airway Disease on Intrapulmonary Vascular Volume in COPD.
机构信息
Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China.
Department of Radiology, China-Japan Friendship Hospital, Beijing, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2022 Aug 25;17:1951-1961. doi: 10.2147/COPD.S368974. eCollection 2022.
BACKGROUND
Previous studies have demonstrated that there is a certain correlation between emphysema and changes in pulmonary small blood vessels in patients with chronic obstructive pulmonary disease (COPD), but most of them were limited to the investigation of the inspiratory phase. The emphysema indicators need to be further optimized. Based on the parametric response mapping (PRM) method, this study aimed to investigate the effect of emphysema and functional small airway disease on intrapulmonary vascular volume (IPVV).
METHODS
This retrospective study enrolled 63 healthy subjects and 47 COPD patients, who underwent both inspiratory and expiratory CT scans of the chest and pulmonary function tests (PFTs). Inspiratory and expiratory IPVV were measured by using an automatic pulmonary vessels integration segmentation approach, the ratio of emphysema volume (Emph%), functional small airway disease volume (fsAD%), and normal areas volume (Normal%) were quantified by the PRM method for biphasic CT scans. The participants were grouped according to PFTs. Analysis of variance (ANOVA) and Kruskal-Wallis H-test were used to analyze the differences in indicators between different groups. Then, Spearman's rank correlation coefficients were used to analyze the correlation between Emph%, fsAD%, Normal%, PFTs, and IPVV. Finally, multiple linear regression was applied to analyze the effects of Emph% and fsAD% on IPVV.
RESULTS
Differences were found in age, body mass index (BMI), smoking index, FEV1%, FEV1/forced vital capacity (FVC), expiratory IPVV, IPVV relative value, IPVV difference value, Emph%, fsAD%, and Normal% between the groups (<0.05). A strong correlation was established between the outcomes of PFTs and quantitative CT indexes. Finally, the effect of Emph% was more significant than that of fsAD% on expiratory IPVV, IPVV difference value, and IPVV relative value.
CONCLUSION
IPVV may have a potential value in assessing COPD severity and is significantly affected by emphysema.
背景
先前的研究表明，在慢性阻塞性肺疾病（COPD）患者中，肺气肿与肺小血管的变化之间存在一定的相关性，但大多数研究仅限于吸气相的研究。肺气肿指标需要进一步优化。基于参数响应映射（PRM）方法，本研究旨在探讨肺气肿和功能性小气道疾病对肺内血管容积（IPVV）的影响。
方法
本回顾性研究纳入了 63 名健康受试者和 47 名 COPD 患者，他们均接受了吸气相和呼气相胸部 CT 扫描和肺功能检查（PFTs）。采用自动肺血管整合分割方法测量吸气相和呼气相 IPVV，采用 PRM 方法对双相 CT 扫描定量肺气肿体积（Emph%）、功能性小气道疾病体积（fsAD%）和正常区体积（Normal%）。根据 PFTs 将参与者分为不同组。采用方差分析（ANOVA）和 Kruskal-Wallis H 检验分析不同组间指标的差异。然后，采用 Spearman 秩相关系数分析 Emph%、fsAD%、Normal%、PFTs 和 IPVV 之间的相关性。最后，采用多元线性回归分析 Emph%和 fsAD%对 IPVV 的影响。
结果
不同组间年龄、体重指数（BMI）、吸烟指数、FEV1%、FEV1/用力肺活量（FVC）、呼气相 IPVV、IPVV 相对值、IPVV 差值、Emph%、fsAD%和 Normal%存在差异（<0.05）。PFTs 结果与定量 CT 指标之间存在较强的相关性。最后，Emph%对呼气相 IPVV、IPVV 差值和 IPVV 相对值的影响大于 fsAD%。
结论
IPVV 可能对评估 COPD 严重程度具有潜在价值，且显著受肺气肿影响。
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