特发性肺纤维化的螺旋CT表现特征与肺功能的相关性

目的 探讨特发性肺纤维化(IPF)的螺旋CT表现特征与肺功能的相关性。方法 对经临床病理证实的32例IPF患者行螺旋CT检查，其中17例对兴趣区追加高分辨率CT扫描。所有病例均于CT检查前后5d内行肺功能检查。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 32例IPF均有不同程度的限制性通气功能障碍。肺功能轻度受损5例，其中4例(80％)有磨玻璃样密度影；中度受损11例中，小叶间隔增厚11例(100％)，小叶内间质增厚9例(82％)，小叶结构变形11例(100％)和支气管血管束增粗10例(91％)；重度受损16例中，蜂窝肺16例(100％)和牵拉性支气管扩张9例(55％)。肺功能重度受损的患者有阻塞性合并限制性通气功能障碍。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。

Idiopathic Pulmonary Fibrosis:Correlation Between Helical CT Findings and Pulmonary Function Test Results

Objective To determine the correlation between helical CT findings and pulmonary function test (PFT) results from patients with idiopathic pulmonary fibrosis(IPF). Methods Helical CT scan was performed in 32 cases with clinically and/or pathologically proved idiopathic pulmonary fibrosis. Pulmonary function test for each patient was performed within 5 days before or after CT scan. The correlation between CT findings and pulmonary function test results was assessed. Results Pulmonary function test revealed characteristic restrictive ventilatory defect with reduction of total lung capacity, residual volume, vital capacity, and diffusing capacity of the lung for carbon monoxide. The patients with different severities of pulmonary function impairment had different CT features. 4 of 5 cases with slight impairment of the pulmonary function had the ground-glass opacity, 11 cases with moderate impairment showed the thickened interlobular septa (11/11, 100%), thickened lobular interstitium (9/11, 82%), distorted lobular structures (11/11, 100%) and thickened bronchovascular bundles (10/11, 91%). 16 cases with marked impairment showed the honeycombing (16/16, 100%) and the traction bronchiectasis (9/16, 55%). Conclusion CT can provide significant information for the assessment of the pathologic severity of idiopathic pulmonary fibrosis. There is good correlation between CT findings and pulmonary function test results. CT combined with pulmonary function test can predict the progression, long term survival and response to therapy.