特发性肺纤维化的HRCT表现与肺功能及支气管肺泡灌洗液细胞学相关性研究

目的认识特发性肺纤维化(IPF)的HRCT影像表现,探讨各征象与肺功能各项指标、支气管肺泡灌洗液细胞学之间有无相关性。方法选取符合IPF诊断标准的患者31例,进行吸气后屏气HRCT扫描,并进行肺功能测定,其中26例患者进行了支气管肺泡灌洗检查。对其中14例患者进行HRCT追踪随访。结果HRCT扫描出现最多的征象是网格影(96.8%)、蜂窝影(74.2%);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DLco均具有很好的负相关性,PaO2与磨玻璃影和CT总评分呈显著负相关。支气管肺泡灌洗液中性粒细胞与磨玻璃影轻度正相关,嗜酸细胞与网格影和CT总评分呈轻度正相关。结论在IPF的HRCT诸多征象中,网格影和/或蜂窝影最具有诊断意义。HRCT主要征象与肺功能参数间有一定的相关性,磨玻璃影反映了肺功能通气障碍,网格影反映了肺功能的弥散障碍,蜂窝影的出现说明了肺的通气功能和弥散功能均受累,CT总评分能很好反映肺功能变化。磨玻璃影与支气管肺泡灌洗液中性粒细胞轻度正相关,嗜酸细胞与网格影和CT总评分呈轻度正相关。

Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in idiopathic pulmonary fibrosis

Objective To recognize HRCT findings of idiopathic pulmonary fibrosis (IPF) and evaluate the correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in IPF. Methods 31 patients were enrolled according to the international diagnostic criterion. HRCT were acquired on multisection CT in supine position during breath holding after inspiration. All patients underwent pulmonary function tests. 26 of 31 patients underwent fibroptic bronchoscopy and BAL. 14 patients were followed up HRCT scan during one year. Results The primary HRCT findings were reticular pattern (96.8%), honeycombing (74.2%). Ground-glass opacities were weak but significantly negatively correlated with FEV1 and FEV1/FEV. The significant negative correlation was found between reticular pattern and DLco. Honeycombing and CT score were significantly negatively correlated with FVC, FEV1, TLC and DLco. PaO2 were significantly negatively correlated with ground-glass opacities and CT score. The results of BAL fluid varied over a wide range. Neutropil counts were slightly positively correlated with ground-glass opacities. Eosinophis were significantly positively correlated with reticular pattern and CT score. Conclusion In HRCT manifestations of IPF, the reticular pattern and/or honeycombing are significant for diagnosis. There are significant correlations between HRCT findings and pulmonary function parameters. Ground-glass opacities is a finding to reflect the pulmonary ventilation abnormality. Reticular pattern reflect the pulmonary diffusion abnormality. Honeycombing reflect the pulmonary function both ventilation abnormality and diffusion abnormality. The CT score can reflect the pulmonary function changes. Ground-glass opacities were slightly positively correlated with neutropil counts. Reticular pattern and CT score were slightly significantly positively correlated with eosinophis.