CT肺动脉成像在COPD中的应用

慢性阻塞性肺疾病(COPD)呈进行性恶化性发展,随病情进展将发生肺血管结构重塑、肺循环血流动力学改变、慢性肺源性心脏病,甚至导致死亡。CT肺动脉成像(CTPA)通过测量肺动脉及右心室各径线,可观察双肺及胸腔的情况,从而对COPD的病变过程进行动态监测,同时能够提供右心改变的信息,完成诊断并评估其严重程度。当CTPA联合超声及MRI检查时,可为临床选择治疗决策提供更多信息。就CTPA在COPD中的应用作一综述。     

低剂量CT扫描及定量分析对慢性阻塞性肺疾病气道病变的应用研究

目的：探讨低剂量 CT 扫描及定量分析在慢性阻塞性肺疾病(COPD)患者气道病变中的应用价值。方法122例研究对象(其中正常对照组34例,稳定期 COPD 88例)均行低剂量 CT 扫描,88例 COPD 同时行肺功能检查。采用定量 CT 气道分析软件分别测量右上叶尖段、两下叶后基底段第3级支气管气道相关参数。结果中度组、重度组及极重度组 COPD 管壁面积百分比(WA %)、气道内周径为10 mm 时的管壁厚度(hypothetical airway with internal perimeter of 10 mm,Pi10)均大于正常对照组(P 均<0.05),极重度组 COPD WA%、Pi10大于轻度组 COPD(P 均<0.05)。重度组 COPD 管壁厚度(T)与体表面积比值(T/BSA)、管壁面积与体表面积比值(WA/BSA)均大于正常对照组及中度组 COPD(P 均<0.05)。COPD WA%、Pi10分别与肺通气功能指标、小气道功能指标呈负相关(r 值范围为-0.34~-0.51,P 均<0.01),且 Pi10与肺容积指标呈正相关(r 值范围为0.32~0.33,P 均<0.05)。结论低剂量 CT 扫描定量分析可为 COPD 气道病变提供客观定量评价信息,气道参数 WA%、Pi10是2个客观评价指标;随着COPD 肺功能程度加重,支气管厚度逐渐增厚。     

慢性阻塞性肺疾病患者肺功能对单孔胸腔镜肺手术安全性的影响

 目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者肺功能对单孔胸腔镜肺部手术相关指标的影响,并评估中重度COPD应用单孔胸腔镜进行肺手术的安全性。方法 回顾性分析上海市肺科医院胸外科2020年1-9月1030例COPD患者行单孔胸腔镜的临床资料。根据慢性阻塞性肺疾病全球倡议解读(GOLD)分级标准将肺功能分为轻度、中重度两组,比较不同程度下患者术中失血量(intraoperative blood loss,IBL)、麻醉时间(anesthesia time,AT)、手术时间(operation time,OT)及术后并发症(postoperative complications,PC)、术后住院天数(postoperative hospital stay days,POD)。结果 所有患者均成功完成手术,安全出院。轻度组与中重度组在术中IBL、AT、OT、POD、PC等指标上差异无统计学意义(P＞0.05)。轻度组与中重度组患者术后并发症的差异无统计学意义。结论 中重度COPD患者较轻度COPD患者术中、术后相关指标改变不明显,应用单孔胸腔镜行肺部手术是安全、可行的。     

High-resolution computed tomography with single-slice computed tomography and 16-channel multidetector computed tomography: a comparison regarding visibility and motion artifacts

Background: High-resolution computed tomography is the image procedure of choice in the evaluation of interstitial lung disease. Multidetector-row computed tomography provides the possibility of simultaneous reconstruction of thin and thick slices from the same raw data, acquired from one single series. Thus, it may be tempting to exclude the step-and-shoot series.

Purpose: To compare high-resolution computed tomography (HRCT step-and-shoot) from single-slice CT (SSCT) and 16-channel multidetector CT (MDCT) in terms of visibility and motion artifacts, and to investigate whether thin images reconstructed from helical MDCT are equal to or better than conventional HRCT by SSCT in terms of visibility and motion artifacts.

Material and Methods: 20 patients underwent HRCT step-and-shoot by SSCT (SSCT step-and-shoot) and MDCT (MDCT step-and-shoot), and a helical MDCT acquisition (MDCT helical). Images from four anatomical levels were analyzed in random order regarding visibility and motion artifacts.

Results: Visibility using MDCT step-and-shoot was significantly better than or equal to SSCT step-and-shoot for segmental bronchi and fissures, but not for subsegmental bronchi. For MDCT helical, visibility was equal to or better than SSCT step-and-shoot for segmental bronchi, but not for fissures and subsegmental bronchi. Concerning motion artifacts, MDCT step-and-shoot and MDCT helical were significantly better than or equal to SSCT step-and-shoot.

Conclusion: The image quality (accounting for motion artifacts and visibility) of SSCT step-and-shoot and MDCT step-and-shoot is comparable. The visibility of anatomic structures in images from MDCT helical is inferior to HRCT step-and-shoot.     

沙美特罗联合噻托溴铵治疗慢性阻塞性肺疾病的效果

 目的 用沙美特罗/丙酸氟替卡松(商品名:舒利迭)联合噻托溴铵(商品名:思力华)治疗分析慢性阻塞性肺疾病(chronic obstructive pulmoriary disease, COPD)的效果。方法 选择2013-2015年确诊为COPD且接受诊治的患者60例,其中接受常规COPD对症治疗方案的患者30例为对照组,另采取沙美特罗/丙酸氟替卡松联合噻托溴铵治疗的30例为观察组。对比两组疗效。结果 对照组总有效率83.3%,观察组总有效率96.7%;观察组高于对照组,差异有统计学意义(P<0.05);观察组FEV₁和FEV₁/FVC均大于对照组,差异有统计学意义(P<0.05);治疗后5个月检测6 min步行距离和生活质量情况,观察组均优于对照组,差异有统计学意义(P<0.05)。结论 用沙美特罗/丙酸氟替卡松联合噻托溴铵方案治疗COPD能提高临床疗效和促进身体功能恢复。     

CT定量分析COPD患者气流受限的影响因素

目的 比较肺气肿及支气管壁厚度对慢性阻塞性肺疾病(COPD)患者气流受限影响的相关性.方法 40例COPD患者为观察组及40健康者为对照组,同期接受肺功能检查后行吸气相MSCT检查.应用Thoracic VCAR软件测量观察组及对照组肺野内支气管管腔面积为8 mm2的管壁面积的平方根(Ai8).同时测量肺气肿患者全肺及各个肺叶肺气肿区域百分比(LAV%).用SPSS2.2统计学软件分析观察组与对照组Ai8.比较观察组全肺及各个肺叶LAV%及Ai8对肺气流受限指标第1秒用力呼气量实测值与预测值的百分比(FEV1%)及第1秒用力呼气量/用力肺活量(FEV1/FVC)的相关性.结果 观察组与对照组Ai8有明显统计学差异.气流受限指标与全肺LAV%和全肺Ai8都有相关性(P<0.05).在各肺叶中,仅右肺下叶的Ai8与气流受限指标有较强相关性.各个肺叶的LAV%对气流受限指标的相关性均大于右肺下叶Ai8.结论 观察组与对照组Ai8有明显统计学差异.LAV%和Ai8都会独立影响气流受限指标;LAV%对COPD患者气流受限的影响大于Ai8, 其顺序为LAV%>右肺下叶Ai8>其他肺叶Ai8.     

Evaluation of automated lung nodule detection on low-dose computed tomography scans from a lung cancer screening program(1)

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the performance of a fully automated lung nodule detection method in a large database of low-dose computed tomography (CT) scans from a lung cancer screening program. Because nodules demonstrate a spectrum of radiologic appearances, the performance of the automated method was evaluated on the basis of nodule malignancy status, size, subtlety, and radiographic opacity. MATERIALS AND METHODS: A database of 393 thick-section (10 mm) low-dose CT scans was collected. Automated lung nodule detection proceeds in two phases: gray-level thresholding for the initial identification of nodule candidates, followed by the application of a rule-based classifier and linear discriminant analysis to distinguish between candidates that correspond to actual lung nodules and candidates that correspond to non-nodules. Free-response receiver operating characteristic analysis was used to evaluate the performance of the method based on a jackknife training/testing approach. RESULTS: An overall nodule detection sensitivity of 70% (330 of 470) was attained with an average of 1.6 false-positive detections per section. At the same false-positive rate, 83% (57 of 69) of the malignant lung nodules in the database were detected. When the method was trained specifically for malignant nodules, a sensitivity of 80% (55 of 69) was attained with 0.85 false-positives per section. CONCLUSION: We have evaluated an automated lung nodule detection method with a large number of low-dose CT scans from a lung cancer screening program. An overall sensitivity of 80% for malignant nodules was achieved with 0.85 false-positive detections per section. Such a computerized lung nodule detection method is expected to become an important part of CT-based lung cancer screening programs.     

脉冲振荡法测定慢性阻塞性肺疾病患者呼吸道阻力的评价

目的 :评价脉冲振荡法 (IOS)在测定慢性阻塞性肺疾病 (COPD)患者肺功能中的临床意义。方法 :采用IOS法测定 4 2 6例老年COPD病人和 2 4 5例健康老年人呼吸阻抗 ,并与常规肺通气功能结果比较。结果 :COPD患者所测粘性阻力值较健康人均有不同程度的增高 ,而外周弹性阻力 (X5)则明显低于健康组。其中周边气道阻力的R5 R2 0 、共振频率(Fres)、总气道阻力 (R5)及代表外周弹性阻力的X5敏感性较高 ,并且随病情加重 ,敏感性越高 ,即FEV1(1秒钟用力呼气量 ) % pre越低 ,检出率越高。 结论 :IOS法测定的粘性阻力等指标可作为COPD气道阻塞的指标 ,特别适用病情重、配合不好的老年患者。     

Imaging phenotypes of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is defined by irreversible airflow obstruction. It is a heterogeneous disease affecting the airways and/or the parenchyma with different severity during the course of the disease. These different aspects of COPD can be addressed by imaging using a combination of morphological and functional techniques. Computed tomography (CT) is the technique of choice for morphological imaging of the lung parenchyma and airways. This morphological information is to be accomplished by functional information about ventilation and perfusion, mainly provided by magnetic resonance imaging (MRI). The comprehensive diagnostic possibilities of CT complemented by MRI will allow for a more sensitive detection, phenotype-driven characterization, and dedicated therapy monitoring of the disease.     

低剂量螺旋CT胸部健康体检价值的探讨

目的:探讨低剂量螺旋CT对胸部健康体检的价值。方法:采用低剂量螺旋CT对1 953例参加健康体检者行胸部扫描,观察肺部、心血管、胸壁(软组织、骨骼)及上腹部的病变。结果:1953例被检者,304例检出肺内非钙化结节,其中21例诊断为肺癌,早期肺癌20例(95%);全部被检者冠状动脉钙化阳性者275例,阳性率为14.1%;胸主动脉钙化阳性者371例,阳性率为19.0%;胸椎骨质增生56例,胸椎压缩骨折8例;乳腺癌1例;脂肪肝23例,肝囊肿10例。结论:采用低剂量螺旋CT胸部体检,不仅可以检出早期肺癌,还可以检出冠状动脉和主动脉钙化斑块、胸壁病变及上腹部病变。一次胸部CT筛查可以检出多脏器具有临床价值的疾病。     

Scimitar syndrome versus meandering pulmonary vein: evaluation with three-dimensional computed tomography

We report two cases of abnormal configuration of the pulmonary venous system of the right lung evaluated with the use of three-dimensional spiral computed tomography (3D-CT). In the first case, an unusual form of scimitar syndrome was detected, consisting of two scimitar veins uniting into a common trunk immediately before their confluence into the inferior vena cava (IVC). The second case concerns a meandering pulmonary vein that followed a circuitous course through the right lung and came in close proximity to the IVC, before draining the entire right lung to the left atrium. In both cases, 3D-CT enabled a non-invasive, detailed anatomic evaluation of the right pulmonary vascular bed.     

肠内免疫营养治疗在慢性阻塞性肺疾病急性发作患者中的临床应用

目的 探讨应用肠内免疫营养制剂对于慢性阻塞性肺疾病急性加重(AECOPD)患者营养状况的改善效果及对免疫和急性炎性反应的影响.方法 纳入2013年1月-2014年6月在海军总医院ICU住院且需行机械通气的AECOPD患者62例,随机分为免疫营养组(n=32,给予瑞能)和对照组(n=30,给予本院营养科自制匀浆膳).两组使用等热量肠内营养,营养素经鼻肠管给予.入院当天及第14、18天抽取静脉血,检测血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平,同时在床旁测上臂肌围(UAMC),比较两组14d脱机率及28d内的机械通气时间.结果 免疫营养组患者14d脱机率明显高于对照组,28d内机械通气时间少于对照组(P＜0.05);PA、TFN及UAMC等营养指标明显高于对照组(P＜0.05),IL-6、CRP、TNF-α等免疫指标明显低于对照组(P＜0.05).结论 AECOPD患者应用免疫肠内营养支持较匀浆膳能更好地改善患者的营养状态、免疫功能,并可下调急性炎症反应水平,提高早期撤机成功率,是一种更为合适的营养支持方法.     

慢性阻塞性肺疾病临床表型的研究进展

慢性阻塞性肺疾病(CORD)是一种气流受限不完全可逆的疾病,临床通常根据气流受限严重程度指导治疗.然而COPD患者在临床表现、疾病进展、治疗反应、肺功能下降程度及生活质量等方面存在显著差异.目前单一使用FEV1评估气流受限程度将COPD进行分类及作为疾病诊断、评估和治疗的手段,不能更好地反映COPD的异质性.近年来有学者试图通过不同的表型对COPD异质性进行描述和研究,认为COPD表型是未来研究的方向.本文就目前该方面的研究进展作一综述.     

老年男性COPD患者骨密度及骨代谢相关指标的观察

目的通过测定老年男性慢性阻塞性肺疾病（COPD）患者的骨密度、骨代谢生化指标,探讨COPD与老年骨质疏松症的关系。方法测定35例老年男性COPD患者及35例健康老年男性的骨密度（BMD）、骨矿含量（BMC）以及血清钙（Ca）、磷（P）及血清碱性磷酸酶（ALP）,对两组检测结果进行比较。结果 COPD组BMD和BMC测定结果明显低于对照组,两组血清Ca、P及ALP相比无明显差异。结论老年COPD患者BMD低于健康老年男性,发生骨质疏松的风险增高。     

慢性阻塞性肺疾病海马1H-MRS成像研究

目的 研究慢性阻塞性肺疾病(COPD)患者海马氢质子磁共振波谱(1H-MRS)的特点.方法 随机选取32例COPD患者和30例健康志愿者分别纳入研究组和对照组.采用1H-MRS检测双侧海马的N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸复合物(Cr).结果 研究组左右侧海马NAA/Cr值均显著低于对照组,差异有统计学意义(t=4.963,P=0.007和t=4.856,P=0.023);研究组左右侧海马Cho/Cr值均显著高于对照组,差异有统计学意义(t=3.469,P=0.013和t=3.019,P=0.047).结论 COPD患者存在海马神经元的代谢异常.     

Brain perfusion abnormalities in chronic obstructive pulmonary disease: comparison with cognitive impairment

OBJECTIVES: To clarify cerebral perfusion distribution and cognitive functions in patients with chronic obstructive pulmonary disease (COPD) according to the hypoxia levels and to assess if there is a relationship between cognitive impairment and cerebral perfusion index. Patients and METHODS: Eight patients with stable hypoxemic COPD (HC), 10 patients with stable nonhypoxemic COPD (NHC), and 10 age-matched healthy volunteers participated in the study. All subjects underwent a complete neuropsychological assessment with the mental deterioration battery (MDB), Wechsler memory scale-revised (WMS-R), color trail test (CCT), and grooved pegboard test (GPT). SPECT examination with Tc-99m HMPAO was performed in all patients and controls. Quantitative analysis was performed by a region of interest (ROI)-based method. RESULTS: The scores of verbal memory, delayed recall and attention were significantly lower in COPD patients (p < 0.01). The scores of other subtests were similar in patients and controls. Comparing NHC patients to HC groups showed that verbal memory was impaired in both groups, but delayed recall and attention scores were significantly worse in HC patients than NHC patients. Perfusion indexes on frontal ROIs in NHC patients and frontal and parietal ROIs in HC patients showed significant decreases. Our scintigraphic findings were correlated with the results of neuropsychological tests. CONCLUSIONS: Our results demonstrate that cerebral perfusion is significantly altered in COPD patients. Hypoxemic patients showed more deterioration in cerebral perfusion and cognitive performance than nonhypoxemic patients. The relationship between decreased perfusion and cognitive impairment and the clinical significance of these results require further studies in larger populations.     

慢性阻塞性肺疾病与DNA短串联重复序列的关联

目的探讨慢性阻塞性肺疾病(COPD)与DNA短串联重复序列的关联性。方法应用第二代DNA遗传标记-短串联重复序列测定患者15个STR基因座,分析慢性阻塞性肺疾病基因座等位基因频率分布情况以及与正常对照组的差异。结果 COPD组与对照组15个基因座等位基因的频率分布有显著差异:D2S1338-25、FGA26频率比对照组明显降低;D12S391-19.3、FGA20.2频率比对照组明显升高。两组比较,差异有统计学意义(P<0.05)。结论 FGA20.2和D12S391-19.3附近可能存在COPD危险STR,而D2S1338-25、FGA26附近可能存在COPD保护STR。     

254例慢性阻塞性肺病急性加重期细菌学及药敏分析

目的探讨慢性阻塞性肺病（COPD）急性加重期病原菌及药物敏感性,为临床合理选择抗生素提供依据。方法回顾性分析我院254例慢性阻塞性肺病急性加重期患者,收集痰标本进行细菌培养及鉴定,并对培养细菌进行药物敏感性分析。结果共检出致病菌262株,其中G-杆菌182株,占69．5％;G＋球菌38株,占14．5％;真菌24株,占9．1％;其他菌株18株,占6．9％。药敏分析发现G-菌对亚胺培南最为敏感,其次为氨曲南,然后为二代以上头孢菌素,包括头孢噻肟、头孢哌酮、头孢他啶等,对一代头孢菌素及青霉素敏感性较低,对万古霉素耐药。G＋菌对亚胺培南、万古霉素及氨曲南敏感性强,对青霉素类及头孢菌素类的敏感性普遍较低。结论COPD急性加重期病原菌复杂多变,多以肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、产气肠杆菌等G-菌为主,对亚胺培南最敏感;其次为G＋球菌,以金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌为主,对亚胺培南、万古霉素的敏感性最强。     

布地奈德氧驱动雾化治疗COPD急性加重期的临床效果

目的 研究布地奈德氧驱动雾化治疗慢性阻塞性肺病(COPD)急性加重期的安全性与有效性.方法 入选2007年3月～2011年9月在呼吸内科诊疗的COPD急性加重期患者123例,随机分成3组,每组41例,分别为布地奈德氧驱动雾化治疗组(B组)、甲基强的松静脉治疗组(M组)以及常规治疗对照组(C组).比较治疗前后3组患者相关临床资料情况.结果 B组和M组治疗后的肺功能、血气情况及临床评分均较治疗前明显改善(P＜0.05);治疗后,B组和M组的肺功能、血气情况及临床评分也均较C组明显改善(P＜0.05).B组与C组的不良反应发生率无统计学差异(P＞0.05),而B组的不良反应发生率明显低于M组(P＜0.05).结论 布地奈德氧驱动雾化可以取代甲强龙静脉治疗COPD急性加重期患者,具有较好的安全性与有效性.