摘要
目的 分析CT肺容积参数评估结缔组织病相关间质性肺疾病(CTD-ILD)患者肺功能、病情严重程度的价值.方法 选取2020 年4 月—2022 年12 月收治的126 例CTD-ILD,根据肺间质病变临床严重程度分级分为Ⅰ级组(43 例)、Ⅱ级组(45 例)、Ⅲ级组(38 例),均接受肺功能检查,采用高分辨率CT检查获取CT肺容积参数[正常肺组织容积(NL)、间质纤维化肺容积(ILDV)、全肺总容积(WL)、正常肺组织容积百分比(NL%)、间质纤维化肺容积百分比(ILDV%)],比较各组肺功能指标[肺总量(TLC)、第 1 秒用力呼气容积(FEV1)、用力肺活量(FVC)、残气量(RV)、第1 秒用力呼气容积占预计值百分比(FEV1%)]、GAP等级评分、图像纤维化评分及CT肺容积参数,分析CT肺容积参数与肺功能指标、GAP等级评分、图像纤维化评分的关系,以CT肺容积参数对CTD-ILDⅢ级进行诊断,并分析其与肺功能指标联合检测对CTD-ILDⅢ级的诊断效能.结果 FVC、FEV1、TLC、RV、FEV1%Ⅰ级组>Ⅱ级组>Ⅲ级组,GAP等级评分、国际纤维化评分Ⅰ级组<Ⅱ级组<Ⅲ级组(P<0.05);NL、WL、NL%Ⅰ级组>Ⅱ级组>Ⅲ级组,ILDV、ILDV%Ⅰ级组<Ⅱ级组<Ⅲ级组(P<0.05);NL、WL、NL%与FVC、FEV1、TLC、RV、FEV1%呈正相关,与GAP等级评分、图像纤维化评分呈负相关(P<0.05);ILDV、ILDV%与GAP等级评分、图像纤维化评分呈正相关,与FVC、FEV1、TLC、RV、FEV1%呈负相关(P<0.05);NL、WL、ILDV、NL%、ILDV%诊断CTD-ILDⅢ级的受试者工作特征曲线下面积(AUC)分别为 0.765、0.715、0.754、0.789、0.768,NL、WL、ILDV、NL%、ILDV%联合诊断的 AUC 最大,为0.944.结论 CTD-ILD患者NL、WL、ILDV、NL%、ILDV%与肺功能联系密切,且联合检测对患者病情严重程度有较高的诊断效能.
Abstract
Objective To analyze the value of CT lung volume parameters in evaluating pulmonary function and se-verity of connective tissue disease-associated interstitial lung disease(CTD-ILD).Methods A total of 126 patients with CTD-ILD treated from April 2020 to December 2022 were selected and divided into grade Ⅰ group(n =43),grade Ⅱ group(n =45)and grade Ⅲ group(n =38)according to the clinical severity of CTD-ILD.All patients received pulmonary function tests.CT lung volume parameters[normal lung volume(NL),interstitial lung disease volume(ILDV),whole lung volume(WLV),percentage of normal lung volume(NL％),percentage of interstitial lung disease volume(ILDV％)]were ob-tained by high-resolution CT examination.The pulmonary function indexes[total lung capacity(TLC),forced expiratory vol-ume in the first second(FEV1),forced vital capacity(FVC),residual volume(RV),forced expiratory volume in the first second to the estimated value(FEV1％)],GAP grade score,image fibrosis score and CT lung volume parameters were com-pared among the groups.The relationship between CT lung volume parameters and pulmonary function index,GAP grade score and image fibrosis score was analyzed,and diagnosis of CTD-ILD severity grade Ⅲ was performed using CT lung volume pa-rameters.The diagnostic efficacy of CT lung volume parameters combined with pulmonary function index in CTD-ILD severity grade Ⅲ was analyzed.Results FVC,FEV1,TLC,RV,and FEV1％were the highest in grade Ⅰ group,followed by grade Ⅱ group and grade Ⅲ group,while GAP grade score and international fibrosis score were the lowest in grade Ⅰ group,fol-lowed by grade Ⅱ group and grade Ⅲ group(P<0.05).NL,WL,and NL％were the highest in grade Ⅰ group,followed by grade Ⅱ group and grade Ⅲ group,while ILDV and ILDV％were the lowest in grade Ⅰgroup,followed by grade Ⅱ group and grade Ⅲ group(P<0.05).NL,WL,and NL％were positively correlated with FVC,FEV1,TLC,RV,and FEV1％,and negatively correlated with GAP grade score and image fibrosis score(P<0.05).ILDV and ILDV％were positively corre-lated with GAP grade score and image fibrosis score,but negatively correlated with FVC,FEV1,TLC,RV and FEV1％(P<0.05).The area under the curve(AUC)of NL,WL,ILDV,NL％and ILDV％in the diagnosis of CTD-ILD severity grade Ⅲ was 0.765,0.715,0.754,0.789 and 0.768,respectively.The AUC of NL,WL,ILDV,NL％and ILDV％in combina-tion for diagnosis was the largest(0.944).Conclusion NL,WL,ILDV,NL％and ILDV％are closely related to pulmona-ry function in CTD-ILD patients,and combined detection has high diagnostic efficacy for the severity of the disease.
基金项目
河北省卫生健康委医学科学研究课题(20201599)
维普
万方数据