COPD支气管动脉变化的CTA影像研究

发布时间：2018-05-02 16:59

本文选题：COPD + 支气管　；参考：《第二军医大学》2013年硕士论文

【摘要】：【研究背景】慢性阻塞性肺疾病（Chronic Obstruction Pulmonary Disease，COPD）是一种以不可逆气流受限为特征的肺部疾病，缺氧与慢性炎症是其病程的重要特征。缺氧与慢性炎症的过程与COPD患者的气道结构重建及血管结构重建密切相关，两者相互促进。支气管动脉作为肺支架结构的营养动脉，在COPD的病程中，由于肺循环受损，肺实质损伤及炎症与缺氧对血管的直接刺激，会发生相应改变。探索COPD患者的支气管动脉改变，为我们研究COPD患者相应并发症的发生提供了相关信息，也为以COPD为背景肺的其他相关疾病的研究拓宽了思路。 COPD支气管动脉解剖CTA研究【目的】对COPD支气管动脉的解剖学特点进行研究，了解COPD患者支气管动脉的解剖学变化特征。【方法】共收集临床及肺功能检查确诊为COPD的患者46例，依据GOLD国际指南标准将研究对象分为GOLD1~4级，并收集患者肺功能检查结果及一般资料。每名患者均Philips Brilliance256iCT进行支气管动脉CTA检查，对原始图像进行0.625mm薄层重建后传至后处理工作站(Extended BrillianceWorkspace TM, PHILIPS)进行后处理。利用多平面重建（MPR）、最大密度投影（MIP）及容积重建（VR）等方法对患者支气管动脉三维重建，评价支气管动脉的起源位置，起源方式、起源象限，以及支气管动脉的分布方式，并对重度及极重度(GOLD3~4级) COPD患者的支气管动脉特点进行深入分析。【结果】全部46例患者共收集支气管动脉118支，右支气管动脉76支（64.41%），1.67支/例；左支气管动脉42支（35.59%），0.92支/例。按照左右支气管动脉分布分型，共观察9种左右支气管动脉分型，其中以R2L1(15例)分型最多见，其次为R1L1（8例）。右支气管动脉主要起源于降主动脉T5~6水平（64支，84.21%），起源方式包括独立起源（27支，35.53%），多支支气管动脉共干起源（CTB）（25支，32.90%）及与肋间动脉共干起源（IBT）（24支，31.58%）三种，其中包括2支共干起源于锁骨下动脉。起源于主动脉的右支气管动脉，最常见的起源象限为主动脉前内侧壁（AM）（32例），其次为内侧壁（M）（19例）和前壁（A）（18例）。左支气管动脉主要起源于降主动脉T5~6水平的36支（85.72%），起源方式包括独立起源（20支，47.62%），CTB起源（22支，52.38%）。起源于主动脉的左支气管动脉，最常见的起源象限为前壁(A)（27例），其次为前外侧壁（AL）（7例）。重度及极重度COPD患者(GOLD3~4级)共25人（GOLD3~4级），共收集支气管动脉74支，包括右支气管动脉46支(62.7%)，左支气管动脉28支（37.3）%，1.12支/例。最常见的分布方式为R2L1。起源水平以降主动脉T5~6水平最多见（右侧：41支，89.13%；左侧：24支，85.72%)。起源方式以CTB最多（右侧：19支，41.31%；左侧：13支，46.43%）。结论支气管动脉的起源动脉、起源位置及分布，支气管动脉分支分布的变异都很大。COPD患者的因肺部长期的缺氧与慢性炎症影响，支气管动脉在解剖学也有一定特征，支气管动脉的支数增多，共干起源的支气管动脉增多。尤其在重度及极重度COPD患者中，左支气管动脉的显示计数增多，，以CTB发出支气管动脉比例增高，是COPD患者支气管动脉解剖的特征体现。 CT血管成像对COPD支气管动脉形态变化的研究【目的】探讨慢性阻塞性肺疾病的支气管动脉在CTA表现上的改变。【材料与方法】共收集43例结合临床病史及肺功能检查诊断为COPD的患者，按GOLD指南将研究对象分为四组（GOLD1级，GOLD2级，GOLD3级，GOLD4级），并收集健康体检者10例为正常对照组。收集所有研究对象对的一般资料及肺功能检查结果待用。利用Philips Brilliance256ict对所有患者进行支气管动脉CTA检查，将原始数据0.625mm薄层重建后，传至工作站(Extended Brilliance Workspace TM, PHILIPS)进行图像后处理，利用多平面重建（MPR）、最大密度投影（MIP）及容积重建（VR）方法进行支气管动脉三维重建。统计支气管动脉数，评价横断面图像中纵隔内支气管动脉断面的特点，在MPR及VR图像上分析支气管动脉形态变化情况，并比较各组间差异及各组与对照组的差异。【结果】 GOLD2~4级的主干计数较对照组显著提高（P0.05）（GOLD2与对照组：P=0.036，GOLD3与对照组：P=0.018，GOLD4与对照组P=0.002）。GOLD3~4支气管动脉分支计数增高（GOLD3与对照组：P=0.003，GOLD4与对照组：P=0.001）。GOLD3~4级较对照组横断面纵隔内小血管断面显著增多(GOLD3与对照组：P=0.030，GOLD4与对照组：P=0.000)。GOLD4级较对照组支气管动脉走形显著迂曲(P=0.029)，GOLD3~4级中支气管动脉发生扭曲成团/簇的出现率显著高于对照组（GOLD3与对照组：P=0.04，GOLD4与对照组：P=0.002）。支气管动脉管径伴随GOLD级别增高而增粗。【结论】COPD的长期慢性炎症会导致支气管动脉在CTA上计数增多，形态迂曲，管径增粗。这有可能会导致COPD相关并发症的发生。 CT血管成像对COPD支气管动脉变化与肺功能关系的研究【目的】利用CTA对COPD支气管动脉的显示及支气管动脉管径与肺功能(PFT)指标间的关系，探索COPD支气管动脉变化与气道重建的关系。【材料与方法】共收集COPD患者43例，收集患者一般资料集分功能检查结果。所有病例均接受支气管动脉CTA检查（Philips，Brilliance256ict），将原始数据0.625mm薄层重建后，传至后处理工作站(Extended Brilliance Workspace TM, PHILIPS)，利用多平面重建（MPR）、最大密度投影（MIP）及容积重建（VR）对患者支气管动脉重建，统计支气管动脉支数，评价支气管动脉的显示情况，测量肺门水平各支支气管动脉管径，并分析支气管动脉管径与肺功能指标（FEV1，FEV1%，FVC，FEV1/FVC）的关系。【结果】共显示支气管动脉102支。左支气管动脉41支（40.2%），平均管径1.51mm。右支气管动脉61支（59.8%），平均管径1.98mm。右支气管动脉管径较左侧粗，具有统计学意义（P=0.001）。右支气管动脉管径与FEV1(r=-0.468，P=0.000)、FEV1%(r=-0.476，P=0.000)、FVC（r=-0.381，P=0.002）、FEV1/FVC(r=-0.468，P=0.000)均呈负相关。左支气管动脉管径与FEV1（r=-0.314，P=0.046）、FEV1%（r=-0.357，P=0.022）呈负相关，与FVC（r=-0.265，P=0.094）及FEV1/FVC(r=-0.284，P=0.072)无显著相关性。【结论】 CTA可清晰显示COPD患者支气管动脉。右支气管动脉管径较左侧粗。右支气管动脉管径均与肺功能指标呈负相关。左支气管动脉管径与FEV1、FEV1/预呈负相关，说明支气管动脉与COPD的气道结构重构关系密切。
[Abstract]:[background] chronic obstructive pulmonary disease (Chronic Obstruction Pulmonary Disease, COPD) is a pulmonary disease characterized by irreversible airflow limitation. Hypoxia and chronic inflammation are an important feature of the course of the disease. The process of hypoxia and chronic inflammation is closely related to the reconstruction of airway structure and the reconstruction of vascular structure in COPD patients. Mutual promotion. The bronchial artery is the nutrient artery of the lung stenting structure. In the course of COPD, the damage of the pulmonary circulation, the injury of the lung parenchyma, the direct stimulation of the inflammation and anoxia on the blood vessels will change accordingly. To explore the changes in the bronchial arteries of the patients with COPD, the relevant information is provided for the study of the corresponding complications of the COPD patients. It also broadens the thinking for the study of other related diseases based on COPD.
CTA study of COPD bronchial artery anatomy
[Objective] to study the anatomical features of the COPD bronchial artery and to understand the characteristics of the anatomical changes of the bronchial arteries in the patients with COPD. [Methods] 46 patients with COPD were collected from the clinical and pulmonary function examination. The subjects were divided into GOLD1~4 grade according to the international standard of GOLD, and the results of the pulmonary function examination were collected and the general results were collected. Data. The bronchial artery CTA examination was performed in each patient with Philips Brilliance256iCT, and the original images were transferred to the postprocessing workstation after 0.625mm TLC reconstruction (Extended BrillianceWorkspace TM, PHILIPS) for post-processing. The patients' bronchus was treated with the methods of multiplanar reconstruction (MPR), maximum density projection (MIP) and volume reconstruction (VR). Three-dimensional reconstruction of the arteries was used to evaluate the origin, origin, origin, quadrant, and distribution of bronchial arteries, and to analyze the characteristics of bronchial arteries in severe and extremely severe (GOLD3~4) COPD patients. [results] total of 118 bronchial arteries were collected in all 46 cases and 76 branches of right bronchial artery (64.41% 1.67 branches / cases, 42 branches of left bronchial artery (35.59%), 0.92 branches / cases. According to the distribution of the left and right bronchial arteries, 9 types of bronchial artery types were observed. Among them, R2L1 (15 cases) was the most common, followed by R1L1 (8). The right bronchial artery originated from the T5~6 level of the descending aorta (64, 84.21%), and the origin of the origin included independent origin (2 7, 35.53%) multiple bronchial artery common stem origin (CTB) (25, 32.90%) and intercostal artery co stem origin (IBT) (24, 31.58%) three species, including 2 branches originating from the subclavian artery. The right bronchial artery originated from the aorta, the most common source quadrant was the anterior medial wall of the aorta (32 cases), and the next to the medial wall (19) (19 cases). The anterior wall (A) (18 cases). The left bronchial artery originated mainly from 36 (85.72%) of the T5~6 level of the descending aorta. The origin of the origin included independent origin (20, 47.62%), CTB origin (22, 52.38%). The origin of the left tracheal artery of the aorta was the most common quadrant of the anterior wall (27), and the second (AL) (7). Severe and extremely severe COPD patients. A total of 25 people (grade GOLD3~4) (grade GOLD3~4) collected 74 bronchial arteries, including 46 branches of right bronchial artery (62.7%), 28 branch of left bronchial artery (37.3)%, 1.12 / cases. The most common distribution pattern was R2L1. origin at the T5~6 level of descending aorta (right side: 41, 89.13%; 24, 85.72%). The way of origin was CTB (CTB) most. Right: 19, 41.31%, left: 13, 46.43%. Conclusion the origin of the bronchial artery, the location and distribution of the origin and distribution of the bronchial artery branch distribution of a large.COPD patients with long-term hypoxia and chronic inflammation of the lung, the bronchial artery in the anatomy also has certain characteristics, the number of bronchial arteries increased, a total of dry up. In the severe and extremely severe COPD patients, the number of the left bronchial arteries increased and the proportion of the bronchial arteries emanate with CTB, which was the feature of the bronchial artery anatomy of the patients with COPD.
Morphological changes of bronchial arteries in COPD with CT angiography
[Objective] to investigate the changes in the CTA performance of the bronchial arteries in chronic obstructive pulmonary disease. [materials and methods] 43 patients with COPD, combined with clinical history and lung function examination, were divided into four groups according to the GOLD Guide (GOLD1, GOLD2, GOLD3, GOLD4), and 10 healthy persons were collected as normal pairs. The general data of all the subjects and the results of pulmonary function examination were collected. Philips Brilliance256ict was used to examine all patients with bronchial artery CTA. After the original data of 0.625mm thin layers were rebuilt, the images were sent to the workstation (Extended Brilliance Workspace TM, PHILIPS) for image post-processing, and multiplanar reconstruction (MPR) was used. The three-dimensional reconstruction of bronchial artery was performed by the maximum density projection (MIP) and the volume reconstruction (VR) method. The number of bronchial arteries was counted, the characteristics of the internal bronchial artery section in the mediastinum were evaluated. The morphological changes of the bronchial arteries were analyzed on the MPR and VR images, and the differences between the groups and the control groups were compared. [results] The count of GOLD2~4 level was significantly higher than that of the control group (P0.05) (GOLD2 and control group: P=0.036, GOLD3 and control group: P=0.018, GOLD4 and control group P=0.002) the.GOLD3~4 bronchial artery branch count increased (GOLD3 and control group: P=0.003, GOLD4 and control group) The increase (GOLD3 and control group: P=0.030, GOLD4 and control group: P=0.000).GOLD4 was significantly higher than that of the control group (P=0.029). The incidence of twisted group / cluster in the middle bronchial artery in GOLD3~4 was significantly higher than that of the control group (GOLD3 and control group: P=0.04, GOLD4 and control group: P=0.002). The bronchial artery diameter accompanied GO [Conclusion] chronic chronic inflammation of COPD can lead to increased number of bronchial arteries in CTA, tortuous morphology and thickening of the diameter of the tube. This may lead to the occurrence of COPD related complications.
Relationship between COPD bronchial artery changes and pulmonary function by CT angiography
[Objective] to explore the relationship between the display of COPD bronchial artery and the relationship between the bronchial artery diameter and the index of pulmonary function (PFT), to explore the relationship between the changes of the bronchial artery and the airway reconstruction of the COPD. [materials and methods] 43 patients with COPD were collected, and the results of the general data collection work were collected. All cases received bronchial arteries. CTA examination (Philips, Brilliance256ict), after the reconstruction of the original data 0.625mm thin layer, passed to the post processing workstation (Extended Brilliance Workspace TM, PHILIPS), using multiplanar reconstruction (MPR), maximum density projection (MIP) and volume reconstruction (VR) to reconstruct the artery of the trachea of the patient, to count the bronchial artery branches, and to evaluate the bronchial artery. The relationship between the bronchial arterial diameter of the bronchi and the bronchial artery diameter was measured, and the relationship between the bronchial artery diameter and the pulmonary function index (FEV1, FEV1%, FVC, FEV1/FVC) was analyzed. [results] 102 branches of the bronchial artery, 41 branches of the left bronchial artery (40.2%), the average diameter of the right bronchial artery 61 branches (59.8%), and the mean diameter of the right bronchial artery were found. The diameter of the pulse tube was larger than that of the left side (P=0.001). The diameter of the right bronchial artery was negatively correlated with FEV1 (r=-0.468, P=0.000), FEV1% (r=-0.476, P=0.000), FVC (r=-0.381, P=0.002), FEV1/FVC (r=-0.468). 4) and FEV1/FVC (r=-0.284, P=0.072) without significant correlation. [Conclusion] CTA can clearly show the bronchial artery in the patients with COPD. The right bronchial artery diameter is larger than that of the left side. The right bronchial artery diameter is negatively correlated with the lung function. The left bronchial artery diameter is negatively correlated with FEV1 and FEV1/, indicating the airway structure of the bronchial artery and COPD. The relationship of reconstruction is close.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9;R816.41

【参考文献】