慢性阻塞性肺疾病肺气肿表型CT GOD评分与肺功能及其预后的相关性研究

发布时间：2018-05-27 11:02

  本文选题：CT + GOD　； 参考：《中国实用内科杂志》2014年S1期

【摘要】：目的探讨Goddard评分CT分级与常规肺功能评价指标相比,对于判定肺气肿型慢性阻塞性肺疾病(COPD)的病情严重程度的临床价值;对肺气肿表型COPD以及非肺气肿COPD患者在上一年的住院情况以及病情严重程度进行评估,并对Goddard评分不同CT分级的患者在上一年的住院情况进行评估,根据研究结果对患者进行预后。方法对2012年2月~2013年2月于本院收治的肺气肿患者80例,采用德国Siemens Difinition 64层螺旋CT机对患者进行扫描,采用Goddard评分法对患者肺部功能进行评分分级,对所有患者的FEV1、FVC、FEV1/FVC、RV、TLC、RV/TLC、DLCO、FEV1%预计值、FVC预计值以及DLCO预计值等进行测量,对Goddard评分与肺功能指标的相关性进行检验;对2012年2月~2013年2月于本院收治的肺气肿表型COPD患者150例和150例非肺气肿表型COPD患者在上一年的住院次数、住院时间、病情严重程度、合并症、病死率等进行比较,对肺气肿表型COPD Goddard评分不同分级患者在上一年的住院情况、合并症等进行比较,从而对患者的疾病进行预后。结果 80例患者的肺部CT表现包括全小叶型肺气肿34例,小叶中心型肺气肿26例,小叶间隔旁型肺气肿17例和疤痕旁型或不规型肺气肿3例;Goddard评分结果显示,轻度肺气肿型COPD48例,中度肺气肿型COPD 26例,重度肺气肿型COPD 6例;CT肺功能Goddard评分与反映肺部通气功能的RV、TLC、RV/TLC显著相关,(r=0.385,0.349,0.455,P0.05),与反映肺部弥散功能的DLCO和DLCO预计值亦显著相关(r=0.771,0.787,P0.05);肺气肿型COPD患者上一年住院1次率与非肺气肿型COPD患者相比较,差异没有统计学意义,但是上一年住院2次率却显著高于非肺气肿型COPD患者,差异具有统计学意义(P0.05);肺气肿型COPD患者上一年的平均住院时间也显著长于非肺气肿型COPD,差异具有统计学意义(P0.05);肺气肿型COPD中的重型AECOPD的发生率显著高于非肺气肿型COPD,差异具有统计学意义(P0.05);肺气肿型COPD患者上一年缺血性心脏病和呼吸衰竭的发病率显著高于非肺气肿型COPD,差异具有统计学意义(P0.05);Goddard评分分级越高,患者合并心力衰竭、缺血性心脏病、恶性肿瘤以及呼吸衰竭的概率随之升高,差异具有统计学意义(P0.05)。结论 Goddard评分CT分级可以作为一种新的指标用于评价肺气肿型COPD的病情严重程度;肺气肿型COPD相比较非肺气肿型COPD更易于获得AECOPD,Goddard评分分级越高者越易于发生AECOPD,值得临床重视与预防。
[Abstract]:Objective to evaluate the clinical value of Goddard score in evaluating the severity of chronic obstructive pulmonary disease (COPD). The hospitalization and severity of emphysematous phenotypic COPD and non-emphysematous COPD patients in the previous year were evaluated, and the hospitalization status of the patients with different Goddard scores in the previous year were evaluated. The prognosis of the patients was evaluated based on the results of the study. Methods Eighty patients with emphysema admitted in our hospital from February 2012 to February 2013 were scanned by Siemens Difinition 64-slice spiral CT machine in Germany, and the pulmonary function was graded by Goddard scoring method. The FEV1 / FVC1 / FVCV / RV / TLCV / TLC / DLCOV 1% predicted value and DLCO predictive value of all patients were measured, and the correlation between Goddard score and pulmonary function index was tested. From February 2012 to February 2013, 150 patients with emphysema phenotype COPD and 150 patients with non-emphysematous phenotype COPD were compared in terms of hospitalization times, duration of hospitalization, severity of illness, complications, mortality and so on. The hospitalization and complications of patients with different COPD Goddard scores of emphysema phenotype in the previous year were compared, and the prognosis of the patients was evaluated. Results the CT findings of 80 patients included 34 cases of lobular emphysema, 26 cases of central lobular emphysema, 17 cases of parafilobular emphysema and 3 cases of para-scar or irregular emphysema. Mild emphysema type COPD48, moderate emphysema type COPD 26 cases, In 6 cases of severe emphysema type COPD, Goddard score of pulmonary function was significantly correlated with RV / TLC, which reflected pulmonary ventilation function, and there was a significant correlation between RV / TLC and DLCO predicted values of pulmonary diffusivity in 6 cases of severe emphysema, and the rate of hospitalization in the previous year in patients with emphysematous COPD were also significantly correlated with the predicted values of DLCO and DLCO, and the rate of hospitalization in the previous year in patients with emphysematous type COPD was significantly correlated with the rate of hospitalization in the previous year and the rate of hospitalization of the patients with emphysematous COPD. Comparison of non-emphysematous COPD patients, The difference was not statistically significant, but the rate of hospitalization twice in the previous year was significantly higher than that in non-emphysematous COPD patients. The difference was statistically significant (P 0.05), and the average hospitalization time of emphysema type COPD patients was significantly longer than that of non-emphysema type COPD (P 0.05), and the incidence of severe AECOPD in emphysema type COPD was significantly higher than that in non-emphysema type COPD. The incidence of ischemic heart disease and respiratory failure in patients with emphysematous COPD in the previous year was significantly higher than that in non-emphysematous type. The incidence of heart failure, ischemic heart disease, malignant tumor and respiratory failure increased with statistically significant difference (P 0.05). Conclusion CT grading of Goddard can be used as a new index to evaluate the severity of emphysematous COPD. Compared with non-emphysematous COPD, the higher the grade of COPD is, the more likely it is to develop AECOPDD, which is worthy of clinical attention and prevention.
【作者单位】： 中南大学湘雅医院;
【分类号】：R563.9
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本文编号：1941759