胸部CT对老年重度慢性阻塞性肺疾病病人的评估价值

doi:10.3969/j.issn.1003-9198.2025.01.011

摘要/Abstract

摘要： 目的探讨高分辨CT(high-resolution computed tomography, HRCT)肺气肿定量分析对无法耐受肺功能检查的老年重度COPD病人疾病严重程度的预测价值。方法共纳入85例住院治疗的老年COPD病人,根据慢性阻塞性肺疾病全球倡议(GOLD)指南推荐标准分为GOLDⅠ、Ⅱ、Ⅲ及Ⅳ组,采用HRCT评估病人CT值小于-950 HU的低密度衰减区体积占全肺体积的百分比(LAA%_-950HU)。对4组间一般资料、血气分析指标、血常规及LAA%_-950HU进行比较分析。采用有序多分类Logistic回归分析GOLD分级的相关因素。采用ROC曲线评估相关影响因素对GOLD Ⅳ级病人的预测价值。结果 4组间病程、PaO₂、PaCO₂和LAA%_-950HU差异均有统计学意义(P＜0.05)。有序多因素Logistic回归分析显示,GOLD分级与病程、PaCO₂以及LAA%_-950HU呈正相关,与外周血嗜酸性粒细胞数呈负相关。ROC曲线分析显示,LAA%_-950HU、PaCO₂预测GOLD Ⅳ级的AUC分别为0.751、0.870,截断值分别为34.8%、42.5 mmHg。结论对于无法耐受肺功能检查的老年病人,尤其是GOLD Ⅳ级病人,可结合LAA%_-950HU及PaCO₂来评价疾病的严重程度,对病人治疗方案的制定及调整具有一定的临床价值。

关键词: 慢性阻塞性肺疾病, 高分辨CT, 低密度衰减区

Abstract: Objective To explore the value of quantitative analysis of emphysema with chest high-resolution computed tomography (HRCT) in the elderly patients with severe chronic obstructive pulmonary disease (COPD)who couldn’t tolerate pulmonary function tests (PFT). Methods A total of 85 hospitalized patients with COPD were enrolled in this study. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, all patients were classified into four groups: GOLD Ⅰ,Ⅱ,Ⅲ and Ⅳ, and comparative analysis of demographic characteristics, blood gas analysis, blood routine and LAA%_-950HU was conducted among the four groups. Ordered multinomial Logistic regression was employed to analyze the related risk factors of GOLD classification. ROC curve was drawn to investigate the predictive value of various indicators for GOLD Ⅳ. Results Duration of COPD, arterial oxygen partial pressure (PaO₂), arterial carbon dioxide partial pressure (PaCO₂), and the percentage of low attenuation area below -950 HU (LAA%_-950HU) were significantly different among the four groups (P＜0.05). Logistic regression analysis indicated that GOLD classification was positively correlated with duration of COPD, PaCO₂ and LAA%_-950HU, but negatively correlated with peripheral blood eosinophil count. Receiver operating characteristic curve analysis showed that the areas under the curve of LAA%_-950HU and PaCO₂ in predicting GOLD grade Ⅳ were 0.751 and 0.870, and the cut-off values were 34.8% and 42.5 mmHg, respectively. Conclusions The pulmonary function in the elderly COPD patients with severe airflow restriction who could not tolerate the PFT can be evaluated based on LAA%_-950HU and PaCO₂, which have certain clinical value for the formulation and adjustment of treatment.

Key words: chronic obstructive pulmonary disease, high-resolution computed tomography, low attenuation area

中图分类号:

R 563.9

李艳, 窦彤, 王肖潇, 任小平, 魏声泓, 温红侠. 胸部CT对老年重度慢性阻塞性肺疾病病人的评估价值[J]. 实用老年医学, 2025, 39(1): 46-50.

LI Yan, DOU Tong, WANG Xiaoxiao, REN Xiaoping, WEI Shenghong, WEN Hongxia. Value of chest high-resolution computed tomography in elderly patients with severe chronic obstructive pulmonary disease[J]. Practical Geriatrics, 2025, 39(1): 46-50.

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