多層螺旋CT在慢性阻塞性肺疾病診斷中的應用

肖虎榜

[摘要]目的 探討多層螺旋CT在慢性阻塞性肺疾病（簡稱慢阻肺）診斷中的應用價值。方法 ?選取我院2018年1月～2019年12月收治的120例慢阻肺患者，依據(jù)1 s用力呼氣容積占預計值百分比（FEV1%）結果將其分為輕度組（n=36）、中度組（n=30）、中重度組（n=24）、重度組（n=18）、極重度組（n=12）。五組均給予多層螺旋CT診斷，比較多層螺旋CT對不同病情程度的檢出率及五組的肺小血管橫截面積。結果 多層螺旋CT共檢出輕度慢阻肺患者22例，檢出率為61.11%（22/36）;檢出中度慢阻肺患者21例，檢出率為70.00%（21/30）;檢出中重度慢阻肺患者17例，檢出率為70.83%（17/24）;檢出重度慢阻肺患者14例，檢出率為77.78%（14/18）;檢出極重度慢阻肺患者11例，檢出率為91.67%（11/12）。極重度組的亞段以下水平血管/肺截面面積（%CSA<5）、CSA亞段水平血管/肺截面面積（%CSA 5～10）值均低于重度組，差異有統(tǒng)計學意義（P<0.05）;重度組的亞段以下水平血管/肺截面面積（%CSA<5）、CSA亞段水平血管/肺截面面積（%CSA 5～10）低于中重度組，差異有統(tǒng)計學意義（P<0.05）;中重度組亞段以下水平血管/肺截面面積（%CSA<5）、CSA亞段水平血管/肺截面面積（%CSA 5～10）低于中度組，差異有統(tǒng)計學意義（P<0.05）;中度組上亞段以下水平血管/肺截面面積（%CSA<5）、CSA亞段水平血管/肺截面面積（%CSA 5～10）低于輕度組，差異有統(tǒng)計學意義（P<0.05）。結論 應用多層螺旋CT診斷慢阻肺的效果較好，可以客觀評估病情的嚴重程度，病情越重的患者其肺小血管面積越小。

[關鍵詞]慢性阻塞性肺疾病;多層螺旋CT;診斷

[中圖分類號] R445.3 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 1674-4721（2020）9（c）-0135-04

[Abstract] Objective To investigate the application value of multi-slice spiral CT in the diagnosis of chronic obstructive pulmonary disease （COPD）. Methods A total of 120 cases of patients with chronic obstructive pulmonary disease who were admitted in the hospital from January 2018 to December 2019 were selected as the subjects. All the patients were divided into the mild group （n=36）， the moderate group （n=30）， the moderate-severe group （n=24）， the severe group （n=18） and the extremely severe group （n=12） according to results of forced expiratory volume in one second prediction （FEV1%）. The five groups were diagnosed by multi-slice spiral CT. The detection rate of multi-slice spiral CT for different degrees of disease and the cross-sectional area of pulmonary small vessels in the five groups were compared. Results A total of 22 patients with mild chronic obstructive pulmonary disease were detected by multi-slice spiral CT， with the detection rate of 61.11% （22/36）. A total of 21 patients with moderate chronic obstructive pulmonary disease were detected， with the detection rate of 70.00% （21/30）. A total of 17 patients with moderate-severe chronic obstructive pulmonary disease were detected， with the detection rate of 70.83% （17/24）. A total of 14 patients with severe chronic obstructive pulmonary disease were detected， with the detection rate of 77.78% （14/18）. A total of 11 patients with extremely severe chronic obstructive pulmonary disease were detected， with the detection rate of 91.67% （11/12）. The blood vessel/lung cross-sectional area of sub-segment level and below （%CSA<5） and blood vessel/lung cross-sectional area of CSA sub-segment level （%CSA 5-10） in the extremely severe group were lower than those in the severe group， the differences were statistically significant （P<0.05）. The blood vessel/lung cross-sectional area of sub-segment level and below （%CSA<5） and blood vessel/lung cross-sectional area of CSA sub-segment level （%CSA 5-10） in the severe group were lower than those in the moderate-severe group， the differences were statistically significant （P<0.05）. The blood vessel/lung cross-sectional area of sub-segment level and below （%CSA<5） and blood vessel/lung cross-sectional area of CSA sub-segment level （%CSA 5-10） in the moderate-severe group were lower than those in the moderate group， the differences were statistically significant （P<0.05）. The blood vessel/lung cross-sectional area of sub-segment level and below （%CSA<5） and blood vessel/lung cross-sectional area of CSA sub-segment level （%CSA 5-10） in the moderate group were lower than those in the mild group， the differences were statistically significant （P<0.05）. Conclusion Multi-slice spiral CT in the diagnosis of chronic obstructive pulmonary disease has better effects， it can objectively evaluate the severity of the condition. The more severe the condition of patients， the smaller the area of pulmonary small vessels.

[Key words] Chronic obstructive pulmonary disease; Multi-slice spiral CT; Diagnosis

慢性阻塞性肺疾?。ê喎Q慢阻肺）的誘發(fā)因素較多且雜，臨床研究人員認為慢阻肺的誘發(fā)因素包括α1-抗胰蛋白酶缺乏、吸煙等，患者常伴有長期反復逐漸加重的咳嗽、喘息、胸悶等癥狀，若不及時給予有效治療，病情惡化，將會增加患者心力衰竭、呼吸衰竭，甚至是肺性腦病的發(fā)生風險，嚴重降低了患者的生存質量[1-2]。目前，臨床上在診斷慢阻肺病癥時，常與支氣管哮喘混淆，進而增加了誤診率，故如何提高對慢阻肺的診斷對后續(xù)治療及患者而言具有重要的臨床意義[3]。多層螺旋CT可以多方位成像，具有較高的空間、時間及對比分辨率，因而被廣泛應用于臨床各領域中，然而關于其對慢阻肺的診斷效果尚存爭議?！?br>