慢性阻塞性肺疾病HRCT分型及CT定量研究

发布时间：2018-03-07 13:06

本文选题：肺疾病　切入点：慢性阻塞性　出处：《广州医学院》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨HRCT评价COPD的方法，根据影像学表现及对COPD进行HRCT分型，研究COPD各型与肺功能、临床特征的关系。材料与方法：收集2009年2月至2011年2月广州医学院第一附属医院广州呼吸疾病研究所收治的108位COPD患者，其中男100例，女8例，年龄46-78岁，平均年龄（66±7）岁，经临床诊断，COPD患者：1级31例，2级39例，3级26例，4级12例。在最大吸气末及最大呼气末屏气扫描，根据HRCT影像表现、支气管管壁增厚情况及CT肺功能定量检查肺气肿程度进行分型。结果：根据支气管管壁增厚程度及肺气肿程度，将COPD患者分为5种类型：（1）A型28例，无或轻度肺气肿，17例未合并管壁增厚，11例合并支气管管壁增厚；（2）M1型19例，存在中度肺气肿及支气管管壁增厚；（3）M2型12例，存在重度或极重度肺气肿和支气管管壁增厚；（4）E1型35例，有中度肺气肿，无支气管管壁增厚；（5）E2型14例，有重度或极重度肺气肿，无支气管管壁增厚。A型、E1型患者的体重指数分别为（23.0±1.9，23.4±3.3）kg/m2，高于E2型、M1型、M2型（19.3±3.6，22.6±3.0，20.0±2.4）kg/m2，各型间差异有统计学意义（F=7.679，P＜0.01）。不同CT分型中吸烟指数差异无统计学意义，COPD临床分级人数及近6个月急性加重频率差异有统计学意义。A型患者的FEV1%、FEV1/FVC分别为（75.6±15.8）%，（62.8±8.0），均优于其他各型，各型间差异有统计学意义，（F值分别为7.076和15.111，，均P＜0.01）。M2型患者的残气量最大，平均值为（184.8±52.1），高于其他各型，差异有统计学意义，（F=5.077，P＜0.05）。M2型患者的残总比平均值为（160.9±17.6），高于其他各型，差异有统计学意义，（F=6.974，P＜0.01）。各型患者肺总量间的差别无统计学意义。在吸气、呼气相CT肺功能各项检查指标中：A型患者肺平均CT值分别为（-877.2±28.5，-761.7±25.3）HU，高于其他各型，差异有统计学意义，（F值分别为20.131和90.595，均P＜0.01）；E2型患者肺气体总容积中分别为（5618.1±961.9,4131.4±1143.6）cm3，大于其他各型，差异有统计学意义，（F值分别为5.933和28.691，均P＜0.01）；A型患者单位体积密度最大，分别为（0.1201±0.0217,0.2338±0.0302)g/cm3,各型间差异有统计学意义，（F值分别为18.931和66.108，均P＜0.01）；E2型患者肺气肿容积分别为（4219.4±898.1，2470.3±1191.9）cm3，高于其他各型，差异有统计学意义，（F值分别为20.120和71.347，均P＜0.01）。结论：通过HRCT和CT肺功能检查能将COPD分为5种类型，各类型的临床特征、常规肺功能、CT肺功能各项指标不同，对临床进一步的个体化治疗有积极的指导意义。
[Abstract]:Objective: to study the relationship between HRCT and pulmonary function and clinical features according to the imaging findings and HRCT classification of COPD. Materials and methods: from February 2009 to February 2011, 108 patients with COPD were collected from Guangzhou Institute of Respiratory Diseases, the first affiliated Hospital of Guangzhou Medical College, including 100 males and 8 females, aged 46 to 78 years, with an average age of 66 卤7 years. According to the clinical diagnosis, 31 cases with grade 1, 39 cases with grade 2 and 39 cases with grade 3 with grade 3 or grade 4 were clinically diagnosed. Breath holding at the maximum inspiratory and expiratory end was performed in 12 cases. According to the HRCT findings, Bronchial wall thickening and CT quantitative examination of pulmonary function were used to type emphysema. Results: according to the degree of bronchial wall thickening and emphysema, the patients with COPD were divided into 5 types: 28 cases of type 1: 1 A, 17 cases of no or mild emphysema without thickening of bronchial wall and 11 cases of type M 1 with thickening of bronchial wall. There were 12 cases of moderate emphysema and thickening of bronchial wall, 35 cases of severe or extremely severe emphysema and thickening of bronchial wall, 35 cases of type E 1, moderate emphysema, 14 cases of type E 2 without thickening of bronchial wall, and 14 cases of severe or very severe emphysema. The BMI of patients without thickening of bronchial wall. A type E 1 was 23.0 卤1.9 卤23.4 卤3.3 kg / m 2, which was higher than that of E2 type M 1 M 1 M 2 (19.3 卤3.6N 22.6 卤3.0 卤2.4 kg / m 2). There was a significant difference between the two types (P < 0.01). There was no significant difference in the number of COPD patients and the number of COPD patients in different CT classification. There were significant differences in the frequency of acute exacerbation in the last 6 months. The FEV1 / FVC of FEV1 / FEV1 / FVC in patients with type A was 75.6 卤15.8% and 62.8 卤8.0%, respectively, which was superior to other types. There were significant differences in F values between different types (7.076 and 15.111, respectively, P < 0.01). The mean value of residual gas in patients with type M2 was 184.8 卤52.1, which was higher than that of other types. The difference was statistically significant (P < 0.05). The average of total residual ratio of patients with type M2 was 160.9 卤17.6g, which was higher than that of other types. The difference was statistically significant (P < 0.01). There was no significant difference in the total lung volume among the patients with different types of pulmonary function. The average CT values of lung in patients with type A of inspiratory and expiratory CT were -877.2 卤28.5- 761.7 卤25.3, respectively, which were higher than those of other types. There were significant differences in F values (20.131 and 90.595, respectively, P < 0.01). The total volume of lung gas in patients with E2 was 5618.1 卤961.9 卤1143.6 cm ~ (3), which was higher than that of other types, and the F values were 5.933 and 28.691, respectively (P < 0.01). It was 0.1201 卤0.0217U 0.2338 卤0.0302g / cm ~ 3 respectively. The F values of the patients with E _ 2 were 18.931 and 66.108, respectively (P < 0.01). The volume of emphysema was 4219.4 卤898.1 卤2470.3 卤1191.9 cm ~ (3), which was higher than that of other types (20.120 and 71.347, respectively, P < 0.01). Conclusion: COPD can be divided into five types by HRCT and CT pulmonary function examination. The clinical characteristics of each type and the indexes of CT pulmonary function of routine pulmonary function are different, which has positive guiding significance for further individualized clinical treatment.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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