CT肺气肿容积及小阴影密集度与尘肺肺功能相关性的研究

赵琪琪; 冯莉; 刘玉全; 王梅芳

doi:10.15953/j.ctta.2021.049

CT肺气肿容积及小阴影密集度与尘肺肺功能相关性的研究

doi: 10.15953/j.ctta.2021.049

赵琪琪^{1, 2a,},
冯莉^{1, 2a},
刘玉全^2a, ,,
王梅芳^2b

1.
锦州医科大学十堰市太和医院研究生培养基地, 湖北十堰442000
1.
综合医疗科；湖北医药学院附属十堰市太和医院
2.
呼吸与危重症医学科，湖北十堰442000 湖北医药学院附属十堰市太和医院

详细信息

作者简介:
赵琪琪：女，锦州医科大学全科医学专业型研究生，主要从事尘肺影像学与肺功能相关研究，E-mail：874933120@qq.com

刘玉全：男，十堰市太和医院主任医师、研究生导师，主要擅长呼吸系统疾病的诊断和治，E-mail：lyqliuyuquan123456@163.com

通讯作者:
男，十堰市太和医院主任医师，研究生导师，主要擅长呼吸系统疾病的诊断和治，E-mail：lyqliuyuquan123456@163.com

中图分类号: R 814
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出版历程
- 收稿日期: 2021-11-23
- 录用日期: 2022-03-28
- 网络出版日期: 2022-04-13
- 刊出日期: 2023-01-31

Correlation between Emphysema Volume and Small Shadow Density on CT and the Lung Function in Pneumoconiosis

ZHAO Qiqi^{1, 2a
,},
FENG Li^{1, 2a},
LIU Yuquan^{2a
, ,},
WANG Meifang^2b

1.
Postgraduate Training Basement of Jinzhou Medicial University, Taihe Hospital, Shiyan 442000, China
1.
Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China Department of General Medicine
2.
Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China Department of Respiratory and Critical Care Medicine

摘要

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。
- CT /
- 尘肺 /
- 肺气肿 /
- 肺功能
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.
- CT /
- pneumoconiosis /
- emphysema /
- lung function

HTML全文

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

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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
数据范围	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

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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
项目	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。

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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
A组	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。

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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
B组	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。

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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
C组	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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参考文献(18)

[1]	韩欢, 徐绍德. 胸部多排螺旋CT扫描诊断职业性尘肺病的效果及准确率分析[J]. 影像研究与医学应用, 2021,5(8): 64−65. doi: 10.3969/j.issn.2096-3807.2021.08.030 HAN H, XU S D. Analysis of effect and accuracy of multi-slice spiral CT in the diagnosis of occupational pneumoconiosis[J]. Imaging Research and Medical Applications, 2021, 5(8): 64−65. (in Chinese). doi: 10.3969/j.issn.2096-3807.2021.08.030
[2]	JONES C M, PASRICHA S S, HEINZE S B, et al. Silicosis in artificial stone workers: Spectrum of radiological high-resolution CT chest findings[J]. Journal Medical Imaging and Radiation Oncology, 2020, 64(2): 241−249. doi: 10.1111/1754-9485.13015
[3]	PEREZ T, GARCIA G, ROCHE N, et al. Société de pneumologie de langue française. Recommandation pour la pratique clinique. Prise en charge de la BPCO. Mise à jour 2012. Exploration fonctionnelle respiratoire. Texte long [French Pulmonary Medicine Society. Guidelines for clinical practice. Management of COPD. Update 2012: Pulmonary function tests: Full length text][J]. Revue Des Maladies Respiratoires, 2014, 31(3): 263−294. doi: 10.1016/j.rmr.2013.11.007
[4]	刘阿茹, 魏华, 邓永红. HRCT肺气肿定量分析与COPD患者疾病相关性分析[J]. 中国CT和MRI杂志, 2021,19(8): 74−76. DOI: 10.3969/j.issn.1672-5131.2021.08.024. LIU A R, WEI H, DENG Y H. Analysis of correlation between quantitative analysisi of HRCT emphysema and COPD patients[J]. Chinese Journal of CT and MRI, 2021, 19(8): 74−76. DOI: 10.3969/j.issn.1672-5131.2021.08.024. (in Chinese).
[5]	卞明敏, 胡茂能. 职业性尘肺病肺部影像表现与肺功能改变关系的研究[J]. 职业卫生与应急救援, 2021,39(5): 519−523. DOI: 10.16369/j.oher.issn.1007-1326.2021.05.008. BIAN M M, HU M N. Study on the relationship pulmonary imaging manifestations and pulmonary function changes in occupational pnuemoconiosis[J]. Occupational Health and Emergency Rescue, 2021, 39(5): 519−523. DOI: 10.16369/j.oher.issn.1007-1326.2021.05.008. (in Chinese).
[6]	ZAPOROZHAN J, LEY S, EBERHARDT R, et al. Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: Comparison of different quantitative evaluations and pulmonary function test[J]. Chest, 2005, 128(5): 3213−3220.
[7]	张雨洁, 俞同福. COPD患者肺气肿程度对气道径线与肺功能相关性的影响[J]. 实用放射学杂志, 2016,32(7): 1028−1032. DOI: 10.3969/j.issn.1002-1671.2016.07.009. ZHANG Y J, YU T F. Infiuence of the degree of emphysema on the correlation between airway line and lung function in COPD patients[J]. Journal of Applied Radiology, 2016, 32(7): 1028−1032. DOI: 10.3969/j.issn.1002-1671.2016.07.009. (in Chinese).
[8]	VOGELMEIER C F, CRINER G J, MARTINEZ F J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary[J]. American Journal of Respiratory and Critical Care Medicine, 2017, 49(6): 557−582.
[9]	GBZ70-2015, 职业性尘肺病的诊断[S].
[10]	翟荣存, 李年春, 刘晓东, 等. 尘肺病小阴影密集度的CT分级方法及参考片探讨[J]. 中华劳动卫生职业病杂志, 2021,39(6): 453−457. DOI: 10.3760/cma.j.cn121094-20200917-00537. ZHAI R C, LI N C, LIU X D, et al. Discussion on CT grading method of small shadow density in pneumoconiosis and refernce film[J]. Chinese Journal of Labor Health and Occupational Diseases, 2021, 39(6): 453−457. DOI: 10.3760/cma.j.cn121094-20200917-00537. (in Chinese).
[11]	MASHIMO S, CHUBACHI S, TSUTSUMI A, et al. Relationship between diminution of small pulmonary vessels and emphysema in chronic obstructive pulmonary disease[J]. Clinical Imaging, 2017, 46: 85−90. doi: 10.1016/j.clinimag.2017.07.008
[12]	余先超, 王朗, 温晓玲, 等. CT肺容积及肺密度与尘肺肺功能的相关性[J]. 中国医学影像学杂志, 2020,28(11): 846−848, 851. DOI: 10.3969/j.issn.1005-5185.2020.11.012. YU X C, WANG L, WEN X L, et al. Correlation of lung volume and lung density with pneumoconiosis[J]. Chinese Journal of Medical Imaging, 2020, 28(11): 846−848, 851. DOI: 10.3969/j.issn.1005-5185.2020.11.012. (in Chinese).
[13]	王雷, 沈聪, 邹常咏, 等. 基于CT定量评估肺气肿肺叶分布特点与肺功能的相关性[J]. 西安交通大学学报(医学版), 2018,39(6): 902−906. DOI: 10.7652/jdyxb201806026. WANG L, SHEN C, ZOU C Y, et al. Quantitative evealuation of the correlation between pulmonary lobe distribution characteristics and lung function in emphysema based on CT[J]. Journal of Xi'an Jiaotong University (Medical Edition), 2018, 39(6): 902−906. DOI: 10.7652/jdyxb201806026. (in Chinese).
[14]	兰长青, 王洁, 黄梅萍, 等. CT肺气肿指数及空间分布对慢性阻塞性肺疾病肺损伤的评估价值[J]. 中国临床医学影像杂志, 2021,32(5): 320−325. DOI: 10.12117/jccmi.2021.05.004. LAN C Q, WANG J, HUANG M P, et al. Evaluation of CT emphysema index and its spatial distribution in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Clinical Medical Imaging, 2021, 32(5): 320−325. DOI: 10.12117/jccmi.2021.05.004. (in Chinese).
[15]	王岩. 探析多层螺旋CT及后处理功能对早期尘肺诊断的应用价值[J]. 中国医疗器械信息, 2020,26(8): 151−152. DOI: 10.15971/j.cnki.cmdi.2020.08.076. WANG Y. Application of multislice spiral CT and post-processing in early diagnosis of pneumoconiosisi[J]. China Medical Device Information, 2020, 26(8): 151−152. DOI: 10.15971/j.cnki.cmdi.2020.08.076. (in Chinese).
[16]	胡必锋, 朱胜康, 翟荣存, 等. CT小阴影密集度判定方法及参考片在矽肺诊断中的应用[J]. 中华放射学杂志, 2021,55(11): 1172−1177. DOI: 10.3760/cma.j.cn112149-20210201-00085. HU B F, ZHU S K, ZHAI R C, et al. Determination of small shadow intensity in CT and application of reference film in diagnosis of silicosis[J]. Chinese Journal of Radiology, 2021, 55(11): 1172−1177. DOI: 10.3760/cma.j.cn112149-20210201-00085. (in Chinese).
[17]	夏养萱, 张健杰, 朱德香, 等. 尘肺病患者胸部螺旋CT影像与肺功能变化研究[J]. 职业卫生与应急救援, 2016,30(4): 267−269, 274. DOI: 10.16369/j.oher.issn.1007-1326.2016.04.001. XIA Y X, ZHANG J J, ZHU D X, et al. Study on spiral CT imaging of chest and pulmonary function in patients with pneumoconiosis[J]. Occupational Health and Emergency Rescue, 2016, 30(4): 267−269, 274. DOI: 10.16369/j.oher.issn.1007-1326.2016.04.001. (in Chinese).
[18]	CHAMPLIN J, EDWARDS R, PIPAVATH S. Imaging of occupational lung disease[J]. Radiologic Clinics of North America, 2016, 54(6): 1077−1096. doi: 10.1016/j.rcl.2016.05.015