HRCT volume measurement of emphysema in patients with bronchial asthma complicated with chronic obstructive pulmonary disease and its correlation with pulmonary function
HUANG Aixia1 YAO Guoxiang2 JIN Chongwu1 LIU Hongwei1 LIU Wenjuan1 ZHANG Huawei1 ZHANG Yan1 LU Liwen1
1.Department of Respiratory, South Campus, the Sixth People′s Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201499, China; 2.Department of Surgery, South Campus, the Sixth People′s Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201499, China
Abstract：Objective To analyze the degree of emphysema on chest high-resolution CT (HRCT) in patients with bronchial asthma complicated with chronic obstructive pulmonary disease (ACO) and to explore its correlation with lung function. Methods From March 2013 to March 2015, in Respiratory Clinic of South Campus of the Sixth People′s Hospital Affiliated to Shanghai University of Medicine & Health Sciences, 69 patients with preliminary diagnosis of bronchial asthma and/or chronic obstructive pulmonary disease (COPD) were collected, according to the GOLD and GINA guide diagnosis standard, they were divided into three groups: asthma group (18 cases), COPD group (37 cases), ACO group (14 cases). All patients underwent lung function measurement and chest HRCT scan. Myrian software carried out three-dimensional reconstruction of the CT image, identified the lung tissue and the low-density region, and calculates the proportion of the low-density region (LAA%) whose CT value was less than -950 Hu. Results The LAA% of left lung, LAA% of right lung and LAA% of whole lung were highly statistically significant in asthma group, COPD group and ACO group (P ＜ 0.01), while the LAA% of left lung, LAA% of right lung and LAA% of whole lung were not statistically significant in ACO group and COPD group (P ＞ 0.05). In ACO group, LAA% of left lung, LAA% of right lung and LAA% of whole lung were negatively correlated with predicted values of FEV1% (r = -0.611, -0.635, -0.672) and FEV1/FVC% (r = -0.699, -0.673, -0.745) (all P ＜ 0.05). There was a positive correlation with RV/TLC% (r = 0.451, 0.381, 0.446, all P ＜ 0.05). Conclusion HRCT of ACO patients shows emphysema similar to that of COPD patients, which is significantly more severe than that of asthma patients. HRCT images of ACO patients with emphysema can reflect the pulmonary ventilation function to a certain extent.
黄爱霞1 姚国相2 金崇武1 刘宏伟1 刘温娟1 张华伟1 张燕1 鲁立文1. 支气管哮喘合并慢性阻塞性肺疾病患者HRCT肺气肿容积测定及其与肺功能的相关性[J]. 中国医药导报, 2019, 16(2): 113-116.
HUANG Aixia1 YAO Guoxiang2 JIN Chongwu1 LIU Hongwei1 LIU Wenjuan1 ZHANG Huawei1 ZHANG Yan1 LU Liwen1. HRCT volume measurement of emphysema in patients with bronchial asthma complicated with chronic obstructive pulmonary disease and its correlation with pulmonary function. 中国医药导报, 2019, 16(2): 113-116.
[1] 张弘，蔡柏蔷.支气管哮喘慢性阻塞性肺疾病重叠综合征简介[J].中华结核和呼吸杂志，2014，37（9）：713-715.
[2] Yanagisawa S，Ichinose M. Definition and diagnosis of asthma-COPD overlap（ACO） [J]. Allergol Int，2018，67（2）：172-178.
[3] Menezes AM，Montes Dom，Pérez-Padilla R，et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma [J]. Chest，2014，145（2）：297-304.
[4] Rhee CK，Yoon HK，Yoo KH，et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma [J]. COPD，2014，11（2）：163-170.
[5] Uchida A，Sakaue K，Inoue H. Epidemiology of asthma-chronic obstructive pulmonary disease overlap （ACO） [J]. Allergol Int，2018，67（2）：165-171.
[6] 谢梦双.胸部定量CT“肺气肿指数“和肺功能MEFV曲线“气道塌陷角“对于哮喘-慢阻肺重叠综合征诊断意义的研究[D].济南：山东大学，2016.
[7] 赵桂华，王文涛，徐金义.肺功能测定的基本要求[J].中华结核和呼吸杂志，2012，35（7）：553-555.
[8] 窦丽阳，于楠，陈颖，等.高分辨CT定量分析老年支气管哮喘-慢性阻塞性肺疾病重叠综合征的临床研究[J].临床和实验医学杂志，2017，16（10）：1025-1029.
[9] Global Strategy for the diagnosis，management，and prevention of chronic obstructive pulmonary disease [EB/OL].http：//www.ginasthma.org/local/uploads/files/GINA_Report，2014，Aug12.pdf
[10] Global Initiative for Chronic Obstructive Lung Disease（GOLD）.Global Strategy for the Diagnosis，Management and Prevention of COPD [EB/OL].http：//www.goldcopd.org/uploads/users/files/GOLD_Report，2015，Feb18.pdf
[11] Soler-Cataluna JJ，Cosio B，Izquierdou JL，et al. Consensus document on the overlap phenotype COPD-asthma in COPD [J]. Arch Bronconeumol，2012，48（9）：331-337.
[12] 于寰，江海林，范丽，等.慢性阻塞性肺疾病与正常志愿者的小气道HRCT定量分析的对照研究[J].实用放射学杂志，2013，29（5）：726-729.
[13] Park YS，Seo JB，Kim N，et al. Texture-based quantification of pulmonary emphysema on high-resolution computed tomography：comparison with density-based quantification and correlation with pulmonary function test [J]. Invest Radiol，2008，43（6）：395-402.
[14] Kaya L，?魻zel D，?魻zel BD. Evaluating Qualitative and Quantitative Computerized Tomography Indicators of Chronic Obstructive Pulmonary Disease and Their Correlation with Pulmonary Function Tests [J]. Pol J Radiol，2017，82（9）：511-515.
[15] Fan L，Xia Y，Guan Y，et al. Characteristic features of pulmonary function test，CT volume analysis and MR perfusion imaging in COPD patients with different HRCT phenotypes [J]. Clin Respir J，2014，8（1）：45-54.
[16] 梁凯轶，余艳芳，周慧.AECOPD患者64层MSCT肺容积成像与肺功能测定的相关性研究[J].临床肺科杂志，2016，21（10）：1805-1807.
[17] 陈淮，郑劲平，周洁，等.低剂量多层螺旋CT扫描对慢性阻塞性肺疾病患者肺功能的定量分析价值[J].中华结核和呼吸杂志，2012，35（4）：291-292.
[18] Tada Y，Suzuki T，Kawata N，et al. Clinical, physiological, and radiological features of asthma–chronic obstructive pulmonary disease overlap syndrome [J]. Int J Obstruct Pulmon Dis，2015（10）：945-954.
[19] Grydeland TB，Thorsen E，Dirksen A，et al. Quantitative CT measures of emphysema and airway wall thickness are related to D（L）CO [J]. Respir Med，2011，105（3）：343-351.
[20] Gao Y，Zhai X，Li K，et al. Asthma COPD Overlap Syndrome on CT Densitometry：A Distinct Phenotype from COPD [J]. COPD，2016，13（4）：471-476.
2019, Vol. 16 
京公网安备 11010502046598号