CT肺功能成像对经支气管镜肺减容术术前筛选靶肺的价值

目的 应用CT肺功能成像检查同时行肺通气灌注核素扫描检查,评价CT肺功能成像检查对经支气管镜肺减容术患者术前筛选靶肺的价值.方法 纳入2011年3月至2012年3月北京天坛医院呼吸科门诊和住院的31例慢性支气管炎患者,均行肺功能、肺部高分辨率CT及肺通气灌注核素扫描检查,依据肺功能检查结果分为2组.正常组9例,男6例,女3例,年龄45 ～ 67岁,平均(55 ±9)岁；阻塞性功能障碍肺气肿组22例,男16例,女6例,年龄32～77岁,平均(55±12)岁.比较肺部高分辨率CT视觉评分、CT肺功能成像参数与肺功能结果之间的相关性,各肺叶的平均CT值和像素指数与通气血流比值各数据之间相关性,探讨CT肺功能成像技术对于确定拟行经支气管镜肺减容术患者的区域性无功能靶区的价值.结果 肺部高分辨率CT评分结果与RV/TLC、FEV1/FVC分级结果比较差异有统计学意义(x2=13.22和13.21,均P＜0.01),提示肺气肿的CT视觉评分与肺功能所示肺气肿严重程度分级不一致；而CT肺功能成像结果与RV/TLC、FEV1/FVC分级结果比较差异无统计学意义(x2 =3.110和2.891,均P＞0.01),提示像素指数-910 HU的CT肺功能成像与肺功能所示肺气肿严重程度分级一致性较好(r=0.262 ～0.470,均P＜0.01),各肺叶的平均CT值和像素指数与通气血流比值相关性较好(r=-0.382 ～0.698,均P＜0.01).结论 CT肺功能成像结果客观,操作简单,与肺功能评估结果和肺通气灌注扫描结果间相关性好,可作为经支气管镜肺减容术术前筛选靶肺的方法之一.     

高分辨率CT在老年慢性阻塞性肺疾病定量诊断中的价值

目的探讨高分辨率计算机断层扫描(HRCT)诊断慢性阻塞性肺疾病(COPD)患者肺功能是否好于常规临床肺功能指标。方法进行详细的临床病史采集和体格检查用于评估肺气肿,包括血清研究、肺功能测试、HRCT扫描、平均肺密度、衰减值分离最少为15%的像素(PERC15)(肺气肿参数)、肺部相对面积衰减CT值<-950 HU(RA950)。结果 92例COPD中度肺气肿患者平均肺密度CT值为(-877±23)HU,PERC15 CT值为(-953±21)HU,RA950值为(16±5)%。在圣乔治呼吸问卷调查表中对肺气肿严重程度上有显著差异的指标是吸烟史、主观肺气肿严重程度、第1秒用力呼气容积(FEV1)、C-反应蛋白(CRP)、年龄、身体质量指数(P<0.001)。3项图像变量和7项客观临床变量(圣乔治呼吸问卷调查、吸烟史、FEV1、CRP、年龄、性别、身体质量指数)有显著的相关性(P<0.05)。结论 HRCT在老年肺气肿的定量诊断中能起到重要作用。     

64层螺旋CT肺功能研究及HRCT在肺间质疾病的应用

目的 评价高分辨力CT(HRCT)对肺间质性疾病诊断的作用,并探讨MSCT肺容积指标与肺功能(PFT)指标之间的相关性.方法 选择50例临床诊断为间质性肺疾病的患者为病例组,对照组为22例CT胸部体检且肺功能正常者,对比两者间各种指标的差异.同时观察所有对象肺HRCT的细微结构的改变.结果 HRCT易于发现肺部间质性病变的网状阴影、小结节阴影、磨玻璃样阴影、肺气肿和细支气管病变.CT肺容积指标中,最大呼气末容积(Vex)与残气量(RV),最大吸气末容积(Vin)与肺总量(TLC),容积差(Vin-Vex)与用力肺活量(FVC),容积比(Vin/Vex)与残气量及肺总量比(RV/TLC),存在着较好的相关性,r值分别为0.91、0.87、0.65、0.65,P＜0.01.结论 HRCT对诊断ILD有很高的价值,MSCT肺容积与PFT容积指标有显著相关性,MSCT肺容积指标能用于临床评价肺功能.     

多层螺旋CT肺容积测定与肺功能检查对肺气肿诊断价值的比较

目的比较多层螺旋CT(MSCT)肺容积测定与肺功能检查(PFT)对肺气肿的诊断价值。方法42例肺气肿患者和40例门诊健康体检者均行MSCT肺容积测定和PFT检查。比较两组MSCT肺容积测定指标与PFT指标,并分析MSCT肺容积测定指标与PFT指标之间的相关性。结果肺气肿组患者Vin、Vex、Vex/Vin等指标明显高于对照组(P0.05),而Vin-Vex明显低于对照组(P0.05);肺气肿组患者TLC、RV、RV/TLC等指标明显高于对照组(P0.05),而FVC、FEV1、FEV1/FVC明显低于对照组(P0.05);Vin、Vex等MSCT肺容积测定指标与TLC、RV等PFT指标相关性最明显(P0.01),Vin-Vex与FVC、Vin/Vex与RV/TLC之间的相关性也最为显著(P0.01)。结论 MSCT可迅速和准确评估肺组织容积指标,与PFT检测指标具有良好的相关性,对肺气肿诊断和评估肺组织通气功能状况有一定的临床价值。     

256层CT定量技术对慢性阻塞性肺病患者肺功能分级的价值

目的探讨CT定量技术评价慢性阻塞性肺疾病(COPD)患者肺实质破坏严重程度及早期发现肺实质改变的应用价值。方法 COPD患者71例依据GOLD标准分为:Ⅰ级20例,Ⅱ级20例,Ⅲ级16例,Ⅳ级15例。采集患者的肺功能检测(PFT)指标:用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1%及FEV1/FVC,并在当天进行胸部CT扫描,并通过Lung Density软件测量肺内低密度区所占比例(LAA%)。采用Bonferroni法比较各级别COPD患者总的LAA%、左、右单侧肺LAA%的差异,通过Pearson相关分析检验LAA%与PFT各参数的相关性。结果Ⅰ级COPD中,左、右肺占比有统计学差异(t=2. 221,P=0. 032 4),余各级COPD组左、右肺占比无统计学差异;各级COPD组LAA%均有统计学差异(P<0. 05)。Pear-son相关分析显示LAA%与反映呼吸道有无阻力的FEV1、FEV1/FVC均有相关性(P<0. 05),与反映COPD严重程度的FEV1%相关性最强(r=0. 948)。结论 CT定量测量指标能够较好地反映COPD患者的肺实质破坏。LAA%与PFT有很好的相关性,对COPD患者疾病严重程度的评价具有重要价值,并对检出其早期肺实质改变有一定意义。     

高分辨力CT扫描与肺功能测验对肺气肿诊断价值的研究

对32例慢性阻塞性肺病（COPD）患者同期进行肺功能测验和肺部高分辨力CT扫描。结果显示肺CT分级与反映肺气肿程度有关的肺功能指标有非常显著的相关性。与肺功能检查相比较，高分辨力肺CT检查是探查有无肺气肿较好的方法，它可以区分正常肺质和轻或中度肺气肿，为肺气肿的定量诊断及早期诊断提供了一种无创伤性的检查方法。     

不同分级慢性阻塞性肺疾病患者胸部定量CT变化的研究

目的 通过分析不同分级慢性阻塞性肺疾病(COPD)稳定期患者胸部定量CT的变化及其与肺功能和症状评分的相关性,探讨其能否做为评估COPD严重程度的方法之一.方法 研究对象为山西医科大学附属大医院呼吸科门诊的90例COPD患者,均行肺功能及胸部定量CT检查,症状评估采用MMRC问卷.根据2011年版GOLD综合评估的方法分为A、B、C和D四组.分别对各组肺功能、胸部定量CT肺气肿评估指标LAA％及症状评分进行相关性分析.结果 ①肺功能:FEV1％pred、VC、DL Adj、FEF75分别在A、B、C和D四组间差异有统计学意义(F分别为59.83,18.56,14.39,16.06,P值均＜0.05);且C、D组均分别小于A和B组,差异均有统计学意义(P值均＜0.05);A、B组间及C、D组间差异均无统计学意义(P值均＞0.05).RV,RV/TLC在A、B、C和D四组间差异无统计学意义(P值均＞0.05).②胸部定量CT:LAA％在CT阈值分别-1 024～-970、-960、-950、-940、-930、-920、-910 HU值下均为一致结果.在-i 024～-910 HU下,A、B、C和D四组间LAA％差异有统计学意义(F=20.22,P＜0.05),两两比较,C和D组LAA％分别大于A和B组,差异均有统计学意义(P值均＜0.05),B组大于A组,差异均有统计学意义(P＜0.05),C组与D组差异无统计学意义(P＞0.05).③相关性:(a)LAA％与肺功能各指标:在-1 024～-910 HU下LAA％与FEV1％ pred、FEF75、DL Adj均呈显著负相关,(r分别为-0.686,-0.509,-0.481,均P＜0.01);与RV和RV/TLC无相关性(P=0.34).(b)LAA％与症状评分:在-1 024～-910 HU下LAA％与MMRC呈显著正相关,(r=0.570,P＜0.01).(c)症状评分与肺功能各项指标:MMRC与FEV1％ pred、FEF75及DL Adj呈显著负相关(r分别为-0.493,-0.330,-0.267,前两者P值均＜0.01,后者P＜0.05).结论 肺气肿可能为A、B两组患者临床症状出现差异的原因之一.COPD患者气流受限严重程度、小气道功能和弥散功能的改变及症状评分与胸部定量CT肺气肿严重程度相关.对于GOLD肺功能分级轻中度以下(FEV1％pred≥50％)的COPD患者,胸部定量CT LAA％评估肺气肿严重程度优于肺功能.胸部定量CT可以做为评估COPD严重程度的方法之一.     

各级慢性阻塞性肺疾病患者HRCT与肺功能相关性研究

目的研究不同级别慢性阻塞性肺疾病高分辨率CT（HRCT）异常定量变化,探讨HRCT定量评价与肺功能的相关性。方法将98例COPD患者依据GOLD方案分级,其中I级22例（第1组）,Ⅱ级26例（第2组）,Ⅲ级24例（第3组）,Ⅳ级26例（第4组）。观察所有人选者肺功能、血气分析、HRCT等检查,比较各组间变化及相关性。结果与第1组比较,第2～4组患者HRCT异常定量评分显著升高,比较差异均有统计学意义（P〈O．05）。而且各组间HRCT定量评价与肺功能分级有良好相关性。结论HRCT定量评价各级COPD患者是一项简单易行的临床方法。     

肺纤维化合并肺气肿肺功能及高分辨CT的特征

目的 探讨肺纤维化合并肺气肿(CPFE)患者临床症状、体征、肺功能和高分辨CT(HRCT)的特征;分析肺纤维化和肺气肿的程度与肺功能之间的关系.方法 前瞻性、随机临床病例对照研究.CPFE患者40例,COPD患者80例.比较两组患者一般特征及肺功能等,探讨CPFE肺纤维化和肺气肿的程度与肺功能之间的相关性.结果 40例CPFE患者,年龄(71.8±8.1)岁,男33例,有吸烟史者36例.病程6个月至15年.临床主要症状为咳嗽(34例)、呼吸困难(32例)及双下肺部爆裂音(23例).与COPD患者比较,CPFE患者PaO2降低(f=-2.016,P＜0.05).与COPD患者比较,CPFE患者FEV1％pred[(72.7±20.0)％vs (53.8±15.6)％,t=5.687,P＜0.01]和FEV1/FVC[(70.4±15.8)％vs (54.3±10.7)％,t=6.590,P＜0.01]增高,RV％ pred[(106.8±51.8)％vs(177.6±72.9)％,t=-5.484,P＜0.01]、TLC％pred[(90.1±22.5)％vs (135.4±86.2)％,t=-3.228,P＜0.01]和DL CO％ pred[(43.6±19.4)％vs (63.5±16.1)％,t=-5.900,P＜0.01]降低;VC％ pred和FVC％ pred两组之间比较差异无统计学意义(t值分别为-0.876、0.450,P值均＞0.05).CPFE患者胸部HRCT的主要表现为同时存在以双上肺野为主的肺气肿和双下肺野为主的肺间质改变.肺气肿表现为小叶中心型肺气肿(87.5％)、旁间隔型肺气肿(27.5％)、全小叶型肺气肿(10.0％)和肺大疱(35.0％).肺间质改变为网格影97.5％,磨玻璃影55.0％,蜂窝肺37.5％.调整性别、年龄和吸烟混杂因素后,肺纤维化程度与DL CO％ pred相关(P＜0.01),肺气肿严重程度与DLCO％ pred和FEV1/FVC相关(P＜0.05).结论 CPFE多发生在男性吸烟者,肺通气功能受损较轻,而弥散功能显著下降.HRCT是CPFE诊断的主要依据.HRCT显示肺纤维化和肺气肿严重者肺弥散功能更差.     

多层螺旋CT肺密度测定与肺气肿患者肺功能的相关性研究

目的探讨多层螺旋CT肺密度测定与肺气肿患者肺功能的相互关系。方法对45例肺气肿患者及40例对照组人员的CT肺密度和肺功能进行测定,并将CT肺密度测定结果与肺功能结果进行对照研究。结果肺气肿患者CT呼、吸气相VD与TLC、FEV1及FEV1/FVC呈显著正相关（P〈0.01）,而与RV/TLC呈显著负相关（P〈0.01）。吸气相全肺MLD与PFT指标无相关性（P〉0.05）。结论对于肺气肿疾病多层螺旋CT肺密度测定与肺功能检测有着密切的关系。     

The relationship between pulmonary function tests, thorax HRCT, and quantitative ventilation-perfusion scintigraphy in chronic obstructive pulmonary disease

We have evaluated the relationship between pulmonary function tests (PFT), thorax high resolution computed tomography (HRCT) images and quantitative ventilation-perfusion (V/Q) scintigraphic studies in 16 male patients (mean age 65.6 +/- 5.5 years) with chronic obstructive pulmonary disease (COPD). The mean forced vital capacity (FVC) value of the patient group was 2352 +/- 642 mL (65.4 +/- 15.8%), whereas mean forced expiratory volume in one second (FEV(1)) was found to be 1150 +/- 442 mL (40.8 +/- 14.9%). The ratio of carbon monoxide diffusion capacity to alveolar ventilation (DLCO/VA) was 3.17 +/- 0.88 mL/min/mmHg/L, and the mean partial oxygen (PaO(2)) and carbon dioxide (PaCO(2)) pressures were 68.5 +/- 11.04 mmHg and 38.9 +/- 5.8 mmHg respectively. For each patient, thorax HRCT and V/Q scintigraphic images of both lungs were divided into upper, mid and lower zones during examination. Visual scoring for the assessment of emphysema on thorax HRCT were used and images were graded from mild to severe (< or = 25% - > or = 76%). Emphysema scores were found to be higher on upper zones with accompanying lowest V/Q ratios. DLCO/VA, DLCO, total emphysema scores, and individual emphysema scores of the upper, mid and lower zones were found to be correlated. As a conclusion, it can be stated that emphysematous changes in COPD patients are more apparent in the upper lung zones, which also have the lowest V/Q ratios.     

Functional analysis in single-lung transplant recipients: a comparative study of high-resolution CT, 3He-MRI, and pulmonary function tests

OBJECTIVE: To develop and evaluate a postprocessing tool to quantify ventilated split-lung volumes on the basis of (3)He-MRI and to apply it in patients after single-lung transplantation (SLTX). High-resolution CT (HRCT) was employed as a reference modality providing split air-filled lung volumes. Lung volumes derived from pulmonary function test results served as clinical parameters and were used as the "gold standard." MATERIAL AND METHODS: Eight patients (mean age, 54 years) with emphysema and six patients (mean age, 58 years) with idiopathic pulmonary fibrosis. All patients were evaluated following SLTX. HRCT was performed during inspiration (slice thickness, 1 mm; increment, 10 mm). For correlation with (3)He-MRI, HRCT images were reconstructed in coronal orientation to match the same anatomic levels. Aerated lung was determined by threshold-based segmentation of CT. (3)He-MRI was performed on a 1.5-T scanner using a two-dimensional, fast low-angle shot sequence in coronal orientation covering the whole lung after inhalation of a 300-mL bolus of hyperpolarized (3)He gas followed by normal room air for the rest of the tidal volume. Lung segmentation on (3)He-MRI was done using different thresholds. RESULTS: In emphysematous patients, (3)He-MRI showed excellent correlation (r = 0.9) with vital capacity, while CT correlated (r = 0.8) with total lung capacity. (3)He-MRI correlated well with CT (r > 0.8) for grafts and native fibrotic lungs. In emphysematous lungs, MRI showed a good correlation (r = 0.7) with the nonemphysematous lung volume from CT. Increasing thresholds in (3)He-MRI reveal differences between aerated and ventilated lung areas with a different distribution in emphysema and fibrosis. CONCLUSIONS: (3)He-MRI is superior to CT in emphysema to demonstrate ventilated lung areas that participate in gas exchange. In fibrosis, (3)He-MRI and CT have a similar impact. The decrease pattern and the intraindividual ratio between ventilation of native and transplanted lungs will have to be investigated as a new surrogate for the ventilatory follow-up in patients undergoing SLTX.     

BODE-index, modified BODE-index and ADO-score in chronic obstructive pulmonary disease: relationship with COPD phenotypes and CT lung density changes

COPD is a heterogeneous disorder whose assessment is going to be increasingly multidimensional. Grading systems such as BODE (Body-Mass Index, Obstruction, Dyspnea, Exercise), mBODE (BODE modified in grading of walked distance), ADO (Age, Dyspnea, Obstruction) are proposed to assess COPD severity and outcome. Computed tomography (CT) is deemed to reflect COPD lung pathologic changes. We studied the relationship of multidimensional grading systems (MGS) with clinically determined COPD phenotypes and CT lung density. Seventy-two patients underwent clinical and chest x-ray evaluation, pulmonary function tests (PFT), 6-minute walking test (6MWT) to derive: predominant COPD clinical phenotype, BODE, mBODE, ADO. Inspiratory and expiratory CT was performed to calculate mean lung attenuation (MLA), relative area with density below-950 HU at inspiration (RAI(-950)), and below -910 HU at expiration (RAE(-910)). MGS, PFT, and CT data were compared between bronchial versus emphysematous COPD phenotype. MGS were correlated with CT data. The prediction of CT density by means of MGS was investigated by direct and stepwise multivariate regression. MGS did not differ in clinically determined COPD phenotypes. BODE was more closely related and better predicted CT findings than mBODE and ADO; the better predictive model was obtained for CT expiratory data; stepwise regression models of CT data did not include 6MWT distance; the dyspnea score MRC was included only to predict RA-950 and RA-910 which quantify emphysema extent. BODE reflect COPD severity better than other MGS, but not its clinical heterogeneity. 6MWT does not significantly increase BODE predictivity of CT lung density changes.     

Computed tomography-based visual assessment of chronic obstructive pulmonary disease: comparison with pulmonary function test and quantitative computed tomography

BackgroundChronic obstructive pulmonary disease (COPD) has variable subtypes involving mixture of large airway inflammation, small airway disease, and emphysema. This study evaluated the relationship between visually assessed computed tomography (CT) subtypes and clinical/imaging characteristics.MethodsIn total, 452 participants were enrolled in this study between 2012 and 2017. Seven subtypes were defined by visual evaluation of CT images using Fleischner Society classification: normal, paraseptal emphysema (PSE), bronchial disease, and centrilobular emphysema (trace, mild, moderate and confluent/advanced destructive). The differences in several variables, including clinical, laboratory, spirometric, and quantitative CT features among CT-based visual subtypes, were compared using the chi-square tests and one-way analysis of variance.ResultsSubjects who had PSE had better forced expiratory volume in 1 second (FEV1) (P=0.03) percentage and higher lung density (P<0.05) than those with moderate to confluent/advanced destructive centrilobular emphysema. As the visual grade of centrilobular emphysema worsened, pulmonary function declined and modified Medical Research Council, COPD assessment test (CAT) score, and quantitative assessment (emphysema index and air trapping) increased. The bronchial subtype was associated with higher body mass index (BMI), better lung function and higher lung density. Participants with trace emphysema showed a rapid increase in functional small airway diseaseConclusionsClassifying subtypes using visual CT imaging features can reflect heterogeneity and pathological processes of COPD.     

Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease

We investigated the relationship between the extent of pulmonary emphysema, assessed by quantitative high-resolution computed tomography (HRCT), and lung mechanics in 24 patients with chronic obstructive pulmonary disease (COPD). The extent of emphysema was quantified as the relative lung area with CT numbers < -950 Hounsfield Units (HU). Patients with COPD had severe airflow obstruction (FEV(1) 35 +/- 15% pred) and severe reduction of CO diffusion constant (DCO/VA 37 +/- 19% pred). Maximal static elastic recoil pressure (Pst(max)) averaged 54 +/- 24% predicted, and the exponential constant K of pressure-volume curves was 258 +/- 116% predicted. Relative lung area with CT numbers < -950 HU averaged 21 +/- 11% (range 1 to 38%). It showed a highly significant negative correlation with DCO/VA (r = -0.84, p < 0.0001), a weak correlation with FEV(1)% predicted, and no correlation with either Pst(max) or constant K. A significant relationship was found between the natural logarithm of K and the full width at half maximum of the frequency distribution of CT numbers, taken as an index of the heterogeneity of lung density (r = 0.68, p < 0.0005). We conclude that currently used methods of assessing the extent of emphysema by HRCT closely reflect the reduction of CO diffusion constant, but cannot predict the elastic properties of the lung tissue.     

A comparative study of computed tomographic techniques for the detection of emphysema in middle-aged and older patient populations]

Helical-scan computed tomography (CT) is now widely utilized as a mass screening procedure for lung cancer. By adding 3 slices of high-resolution CT (HRCT) to the standard screening procedure, we were able to compare the efficacy of helical-scan CT and HRCT in detecting pulmonary emphysema. Additionally, the prevalence of emphysema detected by HRCT was examined as a function of patient age and smoking history. The subjects (106 men and 28 women) were all community-based middle-aged and older volunteers who participated in a mass lung cancer screening program. Based on visual assessments of the CT films, emphysema was detected in 29 subjects (22%) by HRCT, but in only 4 (3%) by helical-scan CT. Although the prevalence of emphysema was higher among subjects with a higher smoking index, no correlations with age were observed. We concluded that the efficacy of helical scan CT in detecting pulmonary emphysema can be significantly improved with the inclusion of 3 slices of HRCT, and confirmed that cigarette smoking is linked to the development of pulmonary emphysema.     

Quantitative computed tomography and aerosol morphometry in COPD and alpha1-antitrypsin deficiency.

Relative area of emphysema below -910 Hounsfield units (RA-910) and 15th percentile density (PD15) are quantitative computed tomography (CT) parameters used in the diagnosis of emphysema. New concepts for noninvasive diagnosis of emphysema are aerosol-derived airway morphometry, which measures effective airspace dimensions (EAD) and aerosol bolus dispersion (ABD). Quantitative CT, ABD and EAD were compared in 20 smokers with chronic obstructive pulmonary disease (COPD) and 22 patients with alpha1-antitrypsin deficiency (AAD) with a similar degree of airway obstruction and reduced diffusion capacity. In both groups, there was a significant correlation between RA-910 and PD15 and pulmonary function tests (PFTs). A significant correlation was also found between EAD, RA-910 and PD15 in the study population as a whole. Upon separation into two groups, the significance disappeared for the smokers with COPD and strengthened for those with AAD, where EAD correlated significantly with RA-910 and PD15. ABD was similar in the two groups and did not correlate with PFT and quantitative CT in either group. In conclusion, based on quantitative computed tomography and aerosol-derived airway morphometry, emphysema was significantly more severe in patients with alpha1-antitrypsin deficiency compared with patients with usual emphysema, despite similar measures of pulmonary function tests.     

The extent of emphysema in patients with COPD

Background and Aims: The global initiative for COPD (GOLD) adopted the degree of airway obstruction as a measure of the severity of the disease. The objective of this study was to apply CT to assess the extent of emphysema in patients with chronic obstructive pulmonary disease (COPD) and relate this extent to the GOLD stage of airway obstruction. Materials and Methods: We included 209 patients with COPD. COPD was defined as FEV₁/FVC < 0.70 and no reversibility to β₂‐agonists. All patients were current smokers with a smoking history of ≥20 pack‐years. Patients were assessed by lung function measurement and visual and quantitative assessment of CT, from which the relative area of emphysema below ?910 Hounsfield units (RA‐910) was extracted. Results: Mean RA‐910 was 7.4% (n = 5) in patients with GOLD stage I, 17.0% (n = 119) in stage II, 24.2% (n = 79) in stage III and 33.9% (n = 6) in stage IV. Regression analysis showed a change in RA‐910 of 7.8% with increasing severity according to GOLD stage (P < 0.001). Combined visual and quantitative assessment of CT showed that 184 patients had radiological evidence of emphysema, whereas 25 patients had no emphysema. Conclusion: The extent of emphysema increases with increasing severity of COPD and most patients with COPD have emphysema. Tissue destruction by emphysema is therefore an important determinant of disease severity in COPD. Please cite this paper as: Shaker SB, Stavngaard T, Hestad M, Bach KS, Tonnesen P and Dirksen A. The extent of emphysema in patients with COPD. The Clinical Respiratory Journal 2009; 3: 15–21.     

High-resolution computed tomography scanning in alpha1-antitrypsin deficiency: relationship to lung function and health status.

The development of computed tomography (CT) has enabled emphysema to be assessed noninvasively. Objective quantification of lung density correlates well with lung function in patients with chronic obstructive pulmonary disease and has been shown to be a sensitive tool for monitoring disease progression. In order to determine the clinical impact of changes seen on high-resolution computed tomography (HRCT), the relationship between the objective quantification of emphysema on HRCT, lung function and health status in 111 patients with alpha1-antitrypsin deficiency was examined (PiZ). The degree of HRCT scan abnormality correlated well (p<0.001 for all comparisons) with forced expiratory volume in one second (r = -0.60- -0.75), specific airway conductance (r = -0.67-0.76), residual volume/total lung capacity (r = 0.46-0.58) and transfer factor of the lung for carbon monoxide (r = -0.64- -0.81). In addition, the CT scans correlated (p<0.001) with health status as assessed by the St. George's Respiratory Questionnaire (SGRQ total: r = -0.38-0.50) and the Short-Form health survey (e.g. physical functioning: r = -0.39-0.54). In summary, other workers have shown high-resolution computed tomography to be a sensitive indicator of disease progression. This study confirms the relationship between high-resolution computed tomography and lung physiology, and suggests the relationship is even stronger in patients with predominantly lower zone pan-lobular emphysema than in usual chronic obstructive pulmonary disease. High-resolution computed tomography also relates to patients disability and impairment as defined by health status questionnaires and, therefore, should be considered as an alternative outcome measure particularly in alpha1-antitrypsin deficiency.     

慢性阻塞性肺疾病的高分辨率CT分型及其与白细胞介素-6的关系

目的 探讨高分辨率CT评价COPD的方法,并依此判断COPD影像学分型及其与气道炎症的关系.方法 收集2007年11月至2009年3月上海交通大学医学院附属瑞金医院收治的84例COPD稳定期患者,其中男59例,女25例,年龄34～81岁,平均年龄(67±11)岁,进行胸部高分辨率CT扫描和肺功能检查,根据高分辨率CT影像中肺气肿程度和支气管管壁增厚情况进行分型,并测定其中30例的呼出气冷凝液中白细胞介素(IL)-6的水平.结果 根据胸部高分辨率CT表现,将COPD患者分为3种类型:(1)A型(34例):无或轻微肺气肿,合并或不合并支气管管壁增厚;(2)E型(23例):有肺气肿,无支气管管壁增厚;(3)M型(27例):有肺气肿和支气管管壁增厚.A型患者的平均体重指数为(25.1±4.4)kg/m~2,明显高于E型和M型[(22.5±4.1)和(21.3±3.4)kg/m~2],差异有统计学意义(F=6.732,P＜0.01).A型中轻度呼吸困难者(15/34例)明显多于E型(2/23例)和M型(6/27例),差异有统计学意义(χ~2=9.097,P＜0.05).E型的中、重度咳痰者(均为0/23例)明显少于A型(2/34)和M型(4/27),差异有统计学意义(χ~2=8.702,P＜0.05).A型患者的FEV_1/FVC和FEV_1占预计值%分别为(67±11)%和(72±24)%,明显高于E型[(53±14)%和(52±26)%]和M型[(53±14)%和(51±25)%],差异均有统计学意义(F值分别为10.252和6.508,均P＜0.01).A型患者的深吸气量/肺总量为(41±17)%,明显高于E型和M型[(33±13)%和(28±13)%],差异有统计学意义(F=5.964,P＜0.01).A型患者的残气容积/肺总量为(37±9)%,明显低于E型和M型[(44±10)%和(45±8)%],差异有统计学意义(F=6.954,P＜0.01).M型患者的呼出气冷凝液中IL-6水平为(25.6±4.4)ng/L,明显高于A型和E型[(19.9±6.3)和(16.7±2.1)ng/L],差异有统计学意义(F=7.749,P＜0.01).结论 COPD高分辨率CT3种分型的临床特征不同,且与肺功能及气道炎症相关.