Correlation between Emphysema Volume and Small Shadow Density on CT and the Lung Function in Pneumoconiosis
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摘要: 目的:比较尘肺患者肺气肿程度及肺部小阴影对肺功能的影响。方法:选择2015年至2020年间十堰市太和医院收治的明确诊断尘肺且合并肺气肿的患者96名,进行胸部CT检查及肺功能测定;采用64排螺旋CT(GE Optima CT 680)进行三维容量测量系统定量分析全肺、左右肺、各肺上中下肺野低衰减区容积百分比(LAV%),并根据全肺LAV% 将其分为A组:LAV%<15%,B组:LAV%15%~30%,C组:LAV%>30% 三组,分析肺气肿分布特点及与肺功能的相关性;将胸片评定小阴影密集度的标准应用于CT中得出CT图像的全肺、左右肺、上中下肺野小阴影密集度(SSD),并分析与肺功能的相关性。结果:全肺SSD与FEV1、TLC、PEF、MEF75%、MEF25% 呈负相关,与RV/TLC呈正相关;全肺、左肺、右肺、及上中下肺野LAV% 与FEV1、FEV1%、DLCO、PEF、MEF75%、MEF50%、MEF25% 呈负相关,与RV、RV/TLC% 呈正相关;当LAV%>30% 时,即C组LAV% 与肺功能FEV1、FEV1%、DLCO、RV/TLC、PEF、MEF75%、MEF50%、MEF25% 间的相关性较A组和B组好;肺部小阴影密集度与肺通气功能、容积参数有一定相关性,但与弥散功能相关性较弱。结论:尘肺患者肺气肿程度及小阴影密集度与肺功能均有一定相关性,但肺气肿较小阴影密集度与肺功能相关性更好,且能在一定程度上评估尘肺患者肺损伤程度,值得临床推广应用。Abstract: Objective: To compare the influence of emphysema and lung small shadow on the lung function of patients with pneumoconiosis. Methods: We selected 96 patients who were admitted to the Taihe Hospital (Shiyan city) for pneumoconiosis complicated by emphysema between 2015 and 2020. Chest computed tomography (CT) and lung function assessments were performed. The low attenuation volumes (LAV%) of the whole lung; left and right lungs; and upper, middle, and lower lobes of each lung were quantified using 64-slice spiral CT (GE Optima CT680). Based on the LAV% of the whole lung, the patients were divided into groups A (LAV%<15%), B (LAV%: 15%–30%), and C (LAV% >30%). The small shadow density (SSD) of the whole lung; left and right lungs; and upper, middle, and lower lung fields was calculated by applying the criteria for evaluating SSD on chest radiographs to CT images. The correlation between SSD and lung function was also analyzed. Results: The SSD of the whole lung was negatively correlated with the forced expiratory volume in the first second (FEV1), total lung capacity (TLC), peak expiratory flow (PEF), maximum expiratory flow after 75% of the forced vital capacity (FVC) has not been exhaled (MEF75%), and maximum expiratory flow after 25% of the FVC has not been exhaled (MEF25%), and it was positively correlated with residual volume (RV)/TLC. LAV% was negatively correlated with FEV1, ratio of FEV to FEV1 (FEV1%), carbon monoxide diffusion capacity (DLCO), PEF, MEF75%, maximum expiratory flow after 50% of the FVC has not been exhaled (MEF50%), and MEF25% in the whole lung; left and right lungs; and upper, middle, and lower lung lobes; however, it was positively correlated with RV and RV/TLC%. When LAV% was >30%, the correlation between LAV% and FEV1, FEV1%, DLCO, RV/TLC, PEF, MEF75%, MEF50%, and MEF25% was stronger in group C than in groups A and B. A certain degree of correlation was observed between the SSD in the lungs and the ventilation function and volume parameters; however, the correlation between SSD and the diffusion function was weak. Conclusion: The degree of emphysema and SSD in patients with pneumoconiosis have a certain degree of correlation with the lung function; however, the SSD of emphysema has a relatively better correlation with the lung function. It can be used to evaluate the degree of lung injury in patients with pneumoconiosis to a certain extent and is worthy of clinical application.
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Key words:
- CT /
- pneumoconiosis /
- emphysema /
- lung function
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图 1 分别为A、B、C组部分尘肺患者肺部CT冠状位图像及轴位图像,冠状位图像由气管纵向水平上用等分点的水平线将左右肺各分为上、中、下3个肺野,蓝色区域为肺气肿低衰减区三维图像
Figure 1. Coronal and axial CT images of some patients with pneumoconiosis in groups A, B, and C. The left and right lungs were divided into upper, middle, and lower lung fields from the vertical level of the trachea using equidistant horizontal lines; blue areas present emphysema as three-dimensional images of low-attenuation areas
表 1 各肺野LAV% 数据表
Table 1. LAV% data for each lung field
数据范围 右肺 左肺 右肺 上野 中野 下野 左肺 上野 中野 下野 -1024~-950/% 24.030 24.120 22.428 25.237 23.080 23.053 19.105 26.269 -950~3071/% 75.970 75.881 77.572 74.763 76.920 76.947 80.895 73.731 Total/L 4.300 0.984 1.456 1.860 3.384 0.843 1.128 1.413 表 2 A、B、C组组间总体SSD间差异性分析
Table 2. Comparison of the total SSD among groups A, B, and C
项目 SSD A B B C A C M(Q25,Q75) 2(1,3) 2(2,3) 2(2,3) 2(1,3) 2(1,3) 2(1,3) Z -0.454 -0.373 -0.537 P 0.650 0.767 0.591 注:M(Q25,Q75)为A、B、C三组总体小阴影密集度中位数及四分位数,组间对比不符合正态分布采用非参数检验得到P>0.05,
3组总体小阴影密集度对比差异无统计学意义。表 3 A组各肺野SSD、LAV% 与肺功能指标的相关性分析
Table 3. Analysis of correlation between SSD and LAV% of the lung field and lung function indexes in group A
A组 右上 右中 右下 左上 左中 左下 SSD LAV% SSD LAV% SSD LAV% SSD LAV% SSD LAV% SSD LAV% FEV1 -0.099 0.019 -0.157 -0.093 -0.330* -0.073 -0.228 0.132 -0.317* -0.203 -0.172 0.065 FEV1% 0.159 -0.068 0.037 0.060 -0.124 -0.159 -0.037 0.005 -0.085 -0.337* -0.076 0.082 FVC -0.258 0.020 -0.374* -0.034 -0.388* -0.047 -0.296 0.084 -0.501** -0.231 -0.385* 0.123 DLCO 0.035 -0.022 -0.007 -0.055 0.053 0.119 -0.077 -0.091 0.011 -0.233 -0.079 0.268 RV -0.079 0.192 -0.124 -0.048 0.027 0.070 -0.036 0.194 -0.082 0.082 -0.019 -0.060 TLC -0.004 0.256 -0.030 -0.030 -0.152 0.080 -0.010 0.386* -0.082 0.262 -0.002 0.008 RV/TLC 0.140 0.089 0.058 -0.199 0.187 -0.162 0.176 -0.025 0.164 0.179 0.171 -0.148 PEF 0.020 -0.034 -0.144 -0.145 -0.267 -0.083 -0.091 0.134 -0.250 -0.253 -0.122 0.057 MEF75% -0.055 -0.059 -0.055 -0.127 -0.262 -0.250 -0.061 0.048 -0.225 -0.322* -0.106 0.097 MEF50% -0.057 -0.018 -0.057 -0.032 -0.249 -0.189 -0.110 0.048 -0.213 -0.310* -0.165 0.114 MEF25% -0.116 0.040 -0.116 0.218 -0.251 0.107 -0.095 0.121 -0.227 -0.253 -0.286 0.106 注:* 为P<0.05,**为P<0.01。 表 4 B组各肺野SSD、LAV% 与肺功能指标的相关性分析
Table 4. Analysis of correlation between SSD and LAV% of the lung field and lung function indexes in group B
B组 右上 右中 右下 左上 左中 左下 SSD LAV% SSD LAV% SSD LAV% SSD LAV% SSD LAV% SSD LAV% FEV1 -0.053 0.247 -0.149 -0.036 -0.096 -0.314 -0.123 0.102 -0.009 -0.211 -0.080 -0.521* FEV1% -0.024 0.314 -0.190 0.025 -0.075 -0.304 -0.074 0.128 -0.104 -0.133 -0.147 -0.615* FVC -0.179 -0.078 -0.263 -0.177 -0.079 -0.133 -0.209 -0.038 -0.009 -0.111 -0.161 -0.407* DLCO 0.062 0.157 -0.365 -0.269 -0.154 0.020 0.041 -0.025 0.239 -0.227 -0.288 -0.224 RV -0.170 -0.095 -0.024 -0.112 0.048 0.035 -0.227 -0.025 -0.069 -0.138 0.009 0.009 TLC -0.149 0.155 -0.056 -0.020 -0.268 -0.270 -0.219 0.196 0.147 -0.038 -0.041 -0.113 RV/TLC 0.170 -0.092 0.187 -0.179 0.191 0.450* 0.118 -0.148 0.039 0.051 0.120 0.321 PEF 0.085 0.215 -0.153 -0.015 -0.235 -0.152 -0.044 0.060 0.028 -0.121 -0.140 -0.280 MEF75% 0.072 0.266 -0.055 0.084 -0.002 -0.155 -0.033 0.060 0.021 -0.133 0.013 -0.478* MEF50% 0.048 0.201 -0.067 -0.112 0.015 -0.243 -0.018 0.037 -0.004 -0.259 -0.043 -0.533* MEF25% -0.152 0.199 -0.214 0.024 -0.162 -0.180 -0.238 0.012 -0.176 -0.201 -0.174 -0.479* 注:* 为P<0.05。 表 5 C组各肺野SSD、LAV% 与肺功能指标的相关性分析
Table 5. Analysis of correlation between SSD and LAV% of the lung field and lung function indexes in group C
C组 右上 右中 右下 左上 左中 左下 SSD LAV% SSD LAV% SSD LAV% SSD LAV% SSD LAV% SSD LAV% FEV1 0.324 -0.453* 0.242 -0.435* -0.126 -0.555* 0.030 -0.575* 0.053 -0.554* 0.149 -0.519* FEV1% 0.302 -0.513* 0.209 -0.420* -0.007 -0.532* 0.076 -0.552* 0.068 -0.581* 0.205 -0.389* FVC -0.138 0.010 -0.181 -0.086 -0.284 -0.205 0.036 -0.137 -0.042 -0.156 -0.102 -0.291 DLCO 0.338 -0.282 0.511* -0.506* 0.420* -0.503* 0.395 -0.326 0.492* -0.523* 0.648* -0.410* RV -0.358 0.065 -0.315 0.221 0.260 0.347 -0.191 0.268 -0.199 0.490* -0.563* 0.325 TLC -0.033 -0.285 0.043 0.085 -0.362 -0.110 -0.248 -0.414* -0.136 -0.203 -0.136 -0.233 RV/TLC 0.150 0.042 0.048 0.130 -0.134 0.211 0.242 0.151 0.197 0.299 0.115 0.332 PEF 0.250 -0.535* 0.069 -0.324 -0.211 -0.469* -0.111 -0.575* -0.069 -0.476* 0.003 -0.530* MEF75% 0.161 -0.498* -0.036 -0.297 -0.266 -0.423* -0.199 -0.529* -0.178 -0.395 -0.053 -0.496* MEF50% 0.136 -0.376 -0.077 -0.229 -0.338 -0.329 -0.201 -0.367 -0.153 -0.286 -0.139 -0.431* MEF25% 0.040 -0.312 -0.031 -0.202 -0.377 -0.298 -0.221 -0.306 -0.114 -0.239 -0.141 -0.404* 注:* 为P<0.05。 -
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