Chen Leqing, Wu Feihong, Huang Jia, Yang Jinrong, Fan Wenliang, Nie Zhuang, Jiang Hongwei, Wang Jiazheng, Xia Wenfang, Yang Fan
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
Diagnostics (Basel). 2022 Nov 23;12(12):2921. doi: 10.3390/diagnostics12122921.
Background: The aim of this study was to explore the predictive values of quantitative CT indices of the total lung and lung lobe tissue at discharge for the pulmonary diffusion function of coronavirus disease 2019 (COVID-19) patients at 5 months after symptom onset. Methods: A total of 90 patients with moderate and severe COVID-19 underwent CT scans at discharge, and pulmonary function tests (PFTs) were performed 5 months after symptom onset. The differences in quantitative CT and PFT results between Group 1 (patients with abnormal diffusion function) and Group 2 (patients with normal diffusion function) were compared by the chi-square test, Fisher’s exact test or Mann−Whitney U test. Univariate analysis, stepwise linear regression and logistic regression were used to determine the predictors of diffusion function in convalescent patients. Results: A total of 37.80% (34/90) of patients presented diffusion dysfunction at 5 months after symptom onset. The mean lung density (MLD) of the total lung tissue in Group 1 was higher than that in Group 2, and the percentage of the well-aerated lung (WAL) tissue volume (WAL%) of Group 1 was lower than that of Group 2 (all p < 0.05). Multiple stepwise linear regression identified only WAL and WAL% of the left upper lobe (LUL) as parameters that positively correlated with the percent of the predicted value of diffusion capacity of the lungs for carbon monoxide (WAL: p = 0.002; WAL%: p = 0.004), and multiple stepwise logistic regression identified MLD and MLDLUL as independent predictors of diffusion dysfunction (MLD: OR (95%CI): 1.011 (1.001, 1.02), p = 0.035; MLDLUL: OR (95%CI): 1.016 (1.004, 1.027), p = 0.008). Conclusion: At five months after symptom onset, more than one-third of moderate and severe COVID-19 patients presented with diffusion dysfunction. The well-aerated lung and mean lung density quantified by CT at discharge could be predictors of diffusion function in convalesce.
本研究旨在探讨出院时全肺及肺叶组织定量CT指标对2019冠状病毒病（COVID-19）患者症状出现后5个月时肺弥散功能的预测价值。方法：共90例中重度COVID-19患者在出院时接受CT扫描，并在症状出现后5个月进行肺功能测试（PFT）。采用卡方检验、Fisher精确检验或Mann-Whitney U检验比较1组（弥散功能异常患者）和2组（弥散功能正常患者）之间定量CT和PFT结果的差异。采用单因素分析、逐步线性回归和逻辑回归确定恢复期患者弥散功能的预测因素。结果：症状出现后5个月，共有37.80%（34/90）的患者出现弥散功能障碍。1组全肺组织的平均肺密度（MLD）高于2组，1组通气良好肺（WAL）组织体积百分比（WAL%）低于2组（均p<0.05）。多元逐步线性回归仅将左上叶（LUL）的WAL和WAL%确定为与肺一氧化碳弥散能力预测值百分比呈正相关的参数（WAL：p=0.002；WAL%：p=0.004），多元逐步逻辑回归确定MLD和MLDLUL为弥散功能障碍的独立预测因素（MLD：OR（95%CI）：1.011（1.001，1.02），p=0.035；MLDLUL：OR（95%CI）：1.016（1.004，1.027），p=0.008）。结论：症状出现后5个月，超过三分之一的中重度COVID-19患者出现弥散功能障碍。出院时CT定量的通气良好肺和平均肺密度可能是恢复期弥散功能的预测指标。
