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。     

肺纤维化合并肺气肿综合征肺功能及与高分辨率CT定量相关性分析

目的:分析肺纤维化合并肺气肿(CPFE)综合征患者肺功能及与高分辨率CT(HRCT)定量相关性。方法:本研究为病例对照研究,采用非随机对照的方法收集2011年10月至2021年10月于兰州大学第一医院住院治疗的CPFE综合征患者239例和同期收治的特发性肺纤维化(IPF)患者294例及肺气肿患者287例,根据肺部纤维化...     

Management of subsolid pulmonary nodules in CT lung cancer screening

The distinct appearance and behavior of subsolid pulmonary nodules (SSNs) has resulted in separate recommendations for the management of solitary SSNs, both for incidentally detected as well as for screen detected nodules. However, these guidelines have been based primarily on expert opinion. Recently two studies were published regarding SSNs detected in low-dose computed tomography (LDCT) lung cancer screening, including management advices.     

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 prevalence of pulmonary fibrosis combined with emphysema in patients with lung cancer

Background and objective: Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder of the upper lobe, whereas emphysema is usually associated with lower lobe fibrosis. Although CPFE might increase the risk of lung cancer, the prevalence of CPFE in patients with lung cancer and the incidence of lung cancer in patients with CPFE are unknown. The objective of this study was to determine the prevalence of CPFE in lung cancer patients and to assess the clinical features of these patients. Methods: A total of 1143 patients with lung cancer were reviewed. Based on HRCT performed at diagnosis of lung cancer, patients were categorized into four groups: normal, emphysema, fibrosis and CPFE. The clinical characteristics of patients with CPFE were compared with those of the other groups. Results: CPFE, emphysema and fibrosis were identified in 101 (8.9%), 404 (35.3%) and 15 (1.3%) patients with lung cancer, respectively. The median overall survival of CPFE patients (n = 101, 10.8 months) was significantly less than that of normal patients (n = 623, 53.0 months) or that of patients with emphysema alone (n = 404, 21.9 months). Acute lung injury occurred in 20 (19.8%) patients with CPFE. Conclusions: CPFE is more prevalent than fibrosis in patients with lung cancer, and patients with CPFE had a poorer prognosis in the present study. Further investigation is therefore necessary to elucidate whether CPFE is an independent risk factor for lung cancer.     

Effect of smoking on FEV decline in a cross-sectional and longitudinal study of a large cohort of Japanese males

OBJECTIVE: The effects of cigarette smoking and smoking cessation on age-related pulmonary function decline was assessed in both cross-sectional and longitudinal studies. METHODOLOGY: In the cross-sectional study, pulmonary function data from 11,875 healthy asymptomatic males, aged between 35 and 74, were analysed and correlated with their smoking history and age. In the longitudinal study, changes in pulmonary function were monitored over a 5-year period in 1888 healthy males. RESULTS: The cross-sectional study showed that the difference in FEV(1) between male never smokers and current smokers was small at a younger age but increased with age. A beneficial effect on FEV(1) decline was observed in those who ceased smoking, even within the previous 12 months. Longitudinally, current smokers showed a more rapid decline in FEV(1) over the 5-year period than non-smokers. Those who ceased smoking had lower rates of decline in FEV(1) than those who continued to smoke. CONCLUSION: These results indicate that cigarette smoking is associated with a reduction in pulmonary function, and that smoking cessation has a beneficial effect on FEV(1) decline. Provision of a smoking cessation program for all smokers, especially those showing a rapid decline of FEV(1), should be considered as an important strategy to prevent progression of COPD.     

肺癌孤立性肺结节患者64排螺旋CT扫描影像特点分析

目的 研究64排螺旋CT对肺癌孤立性肺结节(SPN)的诊断价值.方法 选择2015年5月至2019年5月于我院收治的158例经病理证实伴SPN的肺癌患者为对象,按肺癌不同病理类型分为A组(腺癌,112例)、B组(鳞癌,34例)、C组(小细胞癌,12例),均接受64排螺旋CT扫描.比较三组SPN平扫及增强各序列(增强30...     

The effect of emphysema on lung function and survival in patients with idiopathic pulmonary fibrosis

Background and objective: In this study the prevalence, lung function and prognosis of IPF combined with emphysema were evaluated. Methods: Consecutive patients with usual interstitial pneumonia (UIP) on high‐resolution computed tomography (HRCT), with or without emphysema, were assessed retrospectively. The area of fibrosis in the base of the lungs was assessed by HRCT as minimal (<2 cm from the subpleura), moderate (≥2 cm from the subpleura, <1/3 of the area of the base of the lungs) or severe (≥1/3 of the area of the base of the lungs). Results: Among 660 patients with UIP on HRCT, 221 showed upper‐lobe emphysema. Pulmonary function results for patients with UIP and UIP/emphysema, respectively, were: FVC, 71.8% and 87.1%; FEV1%, 86.7% and 87.9%; and DL_CO, 74.3% and 65.2% of predicted. The relationship between FVC, the extent of fibrosis and survival was investigated in 362 patients with records of pulmonary function tests and no lung cancer at the time of entry into the study. Although the extent of fibrosis was similar between the groups, 71.3% of UIP patients met the lung volume criteria for IPF (FVC <80% of predicted), whereas only 26.5% of UIP/emphysema patients met the lung volume criteria for IPF. Median survival was 7.5 years in the UIP group and 8.5 years in the UIP/emphysema group. Conclusions: Emphysema was a common finding in patients with UIP. Patients with UIP and emphysema had greater lung volumes and better survival compared with those with UIP alone.     

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.     

特发性肺纤维化高分辨CT征象与肺功能的相关性

目的探讨特发性肺纤维化(IPF)患者的螺旋CT表现特征与肺功能的相关性。方法经临床病理证实的28例IPF患者进行吸气后屏气HRCT扫描,并进行肺功能测定,观察IPF的CT征象及其解剖分布,评价CT表现特征与肺功能损害的关系。结果28例IPF均有不同程度的限制性通气功能障碍。肺HRCT扫描出现最多的征象是网格影(92.8%)、蜂窝影(82.6%);磨玻璃影与FEV1、FEV1/FEV轻度负相关,网格影与DLco显著负相关,蜂窝影和CT总评分与FVC、FEV1、TLC和DL-co均具有很好的负相关性。结论螺旋CT能准确反应IPF的病理变化,IPF不同程度的肺功能受损与螺旋CT征象存在相关性。两者相结合有助于预测IPF的进展、预后以及疗效反应。     

特发性肺纤维化患者的肺功能及CT影像学相关性分析

目的研究特发性肺纤维化(IPF)患者的肺功能与螺旋CT影像学诊断的相关性。方法分析40例临床诊断IPF患者的肺功能和螺旋CT检查结果。入选的所有病例均在1周之内行肺功能测定和胸部CT扫描。结果螺旋CT的磨玻璃样密度影与一秒末用力呼气率(FEV1/FVC)有负相关性(轻度);弥漫性线网状阴影与一氧化碳弥散量(DLco)和一氧化碳弥散率(DLco/VA)有显著负相关性;蜂窝影与FVC、FEV1、TLC、DLco和DLco/VA均具有一定的负相关性。结论不同程度的IPF患者肺功能参数与螺旋CT影像学征象存在一定的相关性。两种检查方法联合应用对于提高临床工作中IPF检出率及预测IPF的进展、预后及疗效有一定参考价值。     

肺气肿的CT肺功能成像:CT技术与肺功能检查的对照研究

目的　比较高分辨CT(HRCT)、CT肺功能成像及肺功能检查 (PFT)对肺气肿及阻塞性肺疾病 (COPD)的诊断效用。方法　阻塞性通气障碍组 37例 ,正常对照组 2 0名。所有入选者均在 1周内完成CT检查和PFT。比较HRCT视觉评分、CT肺功能成像参数与PFT结果的相关性和差异性。结果　 (1)CT检查发现 ,阻塞性通气障碍组 37例中有 2 3例有肺气肿征象归属肺气肿亚组。 (2 )HRCT视觉评估仅与PFT参数中一氧化碳弥散量 (DLCO)占预计值百分比存在相关性 (r =- 0 731,P <0 0 0 1)。 (3)肺气肿亚组的视觉分数与最大吸气末、呼气末各像素指数 (PI)存在相关性 ,其中分别与PI 950in、PI 950ex相关性最好 (r分别 =0 5 0 6、0 6 10 ,P均 <0 0 0 1)。 (4)利用PI 910in、PI 910ex分别对两组的肺功能进行分级 ,与一秒钟用力呼气容积 /用力肺活量 (FEV1/FVC)比值的分级结果比较 ,差异无显著性 (χ2 分别 =0 5 2 7、3 6 4 5 ,P分别 =0 913、0 30 2 ) ,采用PI 910in对肺气肿亚组分级与FEV1/FVC的分级结果比较 ,差异无显著性 (χ2 =2 5 9,P =0 4 5 9)。结论　HRCT诊断肺气肿较普通CT敏感 ,但受层厚和照射剂量的限制 ,不能用于对全肺的评估。CT肺功能成像结果客观 ,操作简单 ,与HRCT视觉评分及PFT结果相关性好 ,对早期肺气肿的诊     

16层螺旋CT低剂量与常规剂量扫描的对照研究

目的通过对16层螺旋CT肺部低量与常规剂量扫描的对比分析,肺部低剂量检查的临床应用价值及优势。方法分析55例早期肺癌病变并经手术证实的患者,均为采用低剂量扫描体检时发现,短时间内又用常规剂量扫描,低剂量采用（120kV、20Eff．mAs）,常规剂量采用（120kV、100Eff．mAs）扫描,对比分析两种扫描方法对病灶影像显示率及影像质量等因素有无差异性。结果低剂量扫描检查对病灶的显示与常规扫描检查均无明显差异,图像质量优良,纵膈窗图像噪声较大,但不影响纵膈内淋巴结及钙化的冠状动脉的显示。低剂量扫描剂量当量（CTDL）仅为常规扫描的20％。结论肺部CT扫描检查可采用低剂进行扫描,其对肺内病灶的显示与常规cT扫描无差别,并且可以明显减少患者的X线辐射剂量。     

辽宁省男性吸烟者肺功能和6分钟步行距离检测10164例分析

目的探讨健康成年男性吸烟、戒烟及不吸烟人群的肺功能改变及6 min步行距离(6MWD)情况。方法对2006年8月至2009年6月沈阳市、本溪市、朝阳市、抚顺市、鞍山市、锦洲市6个地区10 164例健康成年(35~80岁)男性,进行统一问卷调查及体检,填写问卷后6个月内每隔2个月按常规方法进行肺功能和6MWD测定。结果FEV1、FEV1/FVC%、RV/TCL指标吸烟组与不吸烟组比较,差异有统计学意义(P<0.05)。MMEF指标吸烟组与戒烟组比较,差异有统计学意义(P<0.05),吸烟组与不吸烟组比较,差异有统计学意义(P<0.01),戒烟组与不吸烟组比较,差异有统计学意义(P<0.05)。6MWD指标吸烟组与戒烟组比较,差异有统计学意义(P<0.05),与不吸烟组比较,差异有统计学意义(P<0.01),戒烟组与不吸烟组比较,差异有统计学意义(P<0.05)。戒烟10年以下与戒烟10年以上比较,FEV1/FVC%差异有统计学意义(P<0.05),MMEF差异有统计学意义(P<0.01),6MWD差异有统计学意义(P<0.05)。结论吸烟者在尚无临床症状时,其肺通气功能已有所降低,尤其是小气道功能,亦即导致肺的储备功能明显降低;戒烟后肺功能会有一定程度的改善,其改善程度与戒烟时间长短有关;因此建议不吸烟,吸烟后应尽早戒烟。     

低剂量与常规剂量6排螺旋CT诊断肺癌的临床价值

目的研究探讨低剂量与常规剂量6排螺旋CT诊断肺癌的临床价值。方法将我院收治的368例肺癌高危患者随机均分为两组,低剂量组184例行低剂量肺癌筛查,常规剂量组184例行常规剂量肺癌筛查。随访跟踪5年,统计比较肺癌筛查率、漏诊率、特异性和敏感性等指标。结果低剂量组总检出率为38.0%,常规剂量为38.5%两组诊断敏感性分别为78.6%、80.3%,三年累计检出率分别是25.4%、24.8%,五年生存率为37.2%、37.9%,确诊病例的组织分型、分期比较,组间差异均无统计学意义(P>0.05)。结论低剂量6排螺旋CT能有效诊断肺癌,并降低人体辐射量,安全高效。     

慢性阻塞性肺疾病相关性肺动脉高压的血流动力学和肺功能相关性研究

目的：观察 COPD 相关性肺动脉高压(pulmonary hypertension,PH)患者的血流动力学和肺功能的相关性。方法共入选右心导管确诊的 COPD 相关 PH 患者64例。根据平均肺动脉压和心指数分为2组：36例严重 COPD 相关 PH 和28例非严重 COPD 相关 PH。比较2组患者各项肺功能参数的差异,与血流动力学指标进行相关性分析。结果 COPD 相关 PH 患者的 FVC% pred[(55.03±22.2)%]、FEV1%pred 降低[(31.4±13.1)%];残气量%pred[(184.7±63.4)%]以及气道阻力%pred [(450.9±296.8)%]增高;并伴弥散量%pred[(58.5±31.1)%]降低。无论是肺容量通气指标、气道阻力指标还是弥散功能,严重 COPD 相关 PH 和非严重 PH 2组间差异均无统计学意义。严重 COPD 相关PH 低氧血症明显,PaO 2和 SaO 2较非严重 PH 组分别低10.6 mmHg 及6.3%(95% CI ,-16.1~-5.0;-9.1~-3.5;P <0.01)。COPD 相关 PH 的 PaO 2和 SaO 2和肺动脉平均压负相关。结论COPD 相关 PH 患者存在严重阻塞性通气功能障碍以及中度弥散功能障碍,血流动力学受损程度和两者无明显相关性。但严重 COPD 相关 PH 低氧血症更为显著,提示除了通气弥散功能外,肺血管因素有可能参与其中。