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目的评估慢性阻塞性肺疾病(COPD)不同表现型的CT灌注形态特征,半定量分析灌注异常区,进一步评价与肺功能参数间的相关性。方法应用Philips Brilliance 256层iCT,对63例COPD患者行肺实质灌注扫描,并将63例根据HRCT中是否存在肺气肿和支气管壁增厚分为3种表现型:A型:无肺气肿或存在轻微的肺气肿,不考虑是否合并支气管管壁增厚;E型:存在明显的肺气肿,不合并支气管管壁增厚;M型:同时存在明显的肺气肿和支气管管壁增厚。在此基础上按肺叶水平分析3种表现型的CT灌注缺损形态特征(楔形、局限非楔形、广泛斑片形),计算COPD的3种表现型灌注缺损区与正常区的CT值之比R HU(R HU=HU defective/HU normal)。应用SPSS 18.0软件,采用方差分析及Bonferroni检验进行各型R HU间差异研究,Spearman相关系数分析R HU与肺功能检查指标的相关性。结果 63例COPD患者中,A型38例,E型11例,M型14例。A型的灌注缺损主要以局限非楔形为主,E型与M型主要以广泛斑片形为主。A型与E型间R HU差异有统计学意义(P=0.003),A型与M型、M型与E型间R HU差异均无统计学意义(P>0.05)。A型的R HU与用力呼气第1秒量(FEV1)(R=0.48,P=0.002)、用力呼气第1秒量的实测值与预测值的百分比(FEV1%)(R=0.47,P=0.002)、第1秒率(FEV1/FVC)(R=0.42,P=0.008)及用力肺活量(R=0.57,P=0.01)均呈正相关;E型的R HU与FEV1/FVC(R=0.68,P=0.042)呈正相关;M型的R HU分别与FEV1(R=0.72,P=0.019)、FEV1/FVC(R=0.63,P=0.039)、FEV1%(R=0.62,P=0.043)及FVC(R=0.65,P=0.043)呈正相关。结论 COPD 3种表现型灌注缺损形态及半定量分析指标R HU均存在差异,但R HU与FEV1/FVC均有正相关性。
Objective To evaluate the perfusion characteristics of CT perfusion in different phenotypes of chronic obstructive pulmonary disease (COPD), analyze the perfusion abnormality area semi-quantitatively, and further evaluate the correlation with pulmonary function parameters. Methods Philips Brilliance 256-layer iCT was performed on 63 patients with COPD undergoing pulmonary perfusion scintigraphy. Sixty-three patients were divided into three manifestations according to whether emphysema and bronchial wall thickening were present in HRCT: type A: no emphysema Or there is a slight emphysema, regardless of whether the merger of bronchial wall thickening; E type: there is significant emphysema, bronchial wall thickening does not merge; M type: the existence of significant emphysema and bronchial wall Thickening On this basis, the CT perfusion defect morphological features (wedge shape, localized non-wedge shape and extensive patch shape) of the three phenotypes were analyzed according to the lung lobe level. The ratio of CT values of three types of perfusion defect regions of COPD to normal regions HU (HU = HU defective / HU normal). Using SPSS 18.0 software, ANOVA and Bonferroni test were used to study the differences between R HU and Spearman correlation coefficient to analyze the correlation between R HU and pulmonary function tests. Results Of 63 patients with COPD, 38 were type A, 11 were type E and 14 were type M. A type of perfusion defect is mainly limited to non-wedge-based, E-type and M-type mainly in the majority of patch-shaped. There were significant differences in R HU between type A and type E (P = 0.003). There was no significant difference in R HU between type A and type M, between type M and type E (P> 0.05). (R = 0.48, P = 0.002), the percentage of predicted and predicted first-second forced expiratory volume (FEV1%) between R HU of type A and FEV1 (FEV1) (P = 0.002), FEV1 / FVC (R = 0.42, P = 0.008) and forced vital capacity (R = 0.57, R = 0.72, P = 0.019), FEV1 / FVC (R = 0.63, P = 0.039), FEV1% (R = 0.62, P = 0.043) and FVC (R = 0.65, P = 0.043). Conclusions There are differences in the morphological perfusion defects and semi-quantitative analysis of R COP between the three types of COPD, but there is a positive correlation between R HU and FEV1 / FVC.