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胸部定量CT在慢性阻塞性肺疾病早期诊断中的应用价值

The value of quantitative chest CT in early diagnosis of chronic obstructive pulmonary disease

    摘要
  • 摘要:
    目的 探讨胸部定量CT在早期诊断慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）中的应用价值。
    方法 回顾性分析2013年9月20日至2014年5月20日上海市某社区COPD高危人群受访者，以及复旦大学附属中山医院门诊的COPD高危咨询者共138例的临床资料。所有高危者在基线及1年后均行肺功能及胸部CT检查，将胸部CT图像导入定量CT分析软件，收集定量CT数据。根据1年后的随访肺功能结果分为COPD组（n=40）与非COPD组（n=98），比较2组在基线时肺功能、定量CT指标的差别。采用二元logistic回归分析COPD高危者随访1年后发生COPD的预测指标，通过ROC曲线评估logistic回归模型的效能。
    结果 2组基线时性别、体质量指数（BMI）、第1秒用力呼气的容积占预计值的百分比（FEV1% pred）、气道壁面积比值（WA%）、气道总数（TAC）、气道壁厚度（WT）差异无统计学意义。COPD组的气道内周长为10 mm处气管壁面积的平方根Pi10；3.43（3.30, 3.54）vs 3.23（3.15, 3.36），P＜0.001、低于-950 HU的低衰减区面积百分比（LAA%-950）2.06（0.32, 6.29）vs 0.57（0.25, 1.89），P=0.015均显著高于非COPD组，COPD组平均肺密度（MLD）低于非COPD组（-799.89±35.62）vs（-783.60±43.52），P=0.038。二元logistic回归分析显示，年龄和Pi10是患COPD的影响因素（P＜0.05），ROC曲线下面积为0.791（95% CI 0.714~0.868）。
    结论 在肺功能正常的COPD高危人群中，Pi10、LAA%-950升高的患者1年后COPD发病率高，提示胸部定量CT的指标如Pi10、LAA%-950有助于临床医生识别早期COPD。

     

    Abstract:
    Objective To explore the value of quantitative chest CT in early diagnosis of chronic obstructive pulmonary disease (COPD).
    Methods The clinical data of 138 cases of COPD high-risk patients in Shanghai community and COPD high-risk respondents in outpatient clinic of Zhongshan Hospital, Fudan University from September 20, 2013 to May 20, 2014 were retrospectively analyzed. All high-risk participants underwent pulmonary function and chest CT examination at baseline and 1 year later. Chest CT images were imported into quantitative CT analysis software to collect quantitative CT data. These participants were divided into COPD group (n=40) and non-COPD group (n=98) based on their lung functions after 1 year. The differences in baseline lung function and quantitative CT measurements between the two groups were compared. Binary logistic regression was used to analyze the predictors of COPD in high-risk individuals after 1 year of follow-up, and the efficacy of the logistic regression model was evaluated by ROC curve.
    Results There were no significant differences in gender, body mass index (BMI), the percentage value of forced expiratory volume in 1 second predicted (FEV1% pred), airway wall area ratio (WA%), total airway count (TAC), and airway wall thickness (WT) between the two groups at baseline. Compared to the non-COPD group, the square root of the tracheal wall area at 10 mm from the inner circumference of the airway (Pi10), (3.43 3.30, 3.54 vs 3.23 3.15, 3.36, P < 0.001), and the percentage area of low attenuation regions below -950 HU (LAA% -950), (2.06 0.32, 6.29 vs 0.57 0.25, 1.89, P=0.015) were significantly higher in the COPD group.The mean lung density (MLD) in the COPD group was lower than that in the non-COPD group (-799.89±35.62 vs -783.60±43.52, P=0.038). Binary logistic regression analysis indicated that age and Pi10 were risk factors for COPD (P < 0.05), with an area under the ROC curve of 0.791 (95% CI 0.714-0.868).
    Conclusions In the COPD high-risk population with normal lung function, patients with elevated Pi10 and LAA% -950 have a higher incidence of COPD one year later, suggesting that quantitative chest CT measurements such as Pi10 and LAA% -950 can assist clinicians in identifying early-stage COPD.

     

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