3D-胸部CT估算肺纤维化程度在特发性肺纤维化预后分析中的应用

 目的 探讨3D-CT（three-dimensional CT）估算的肺纤维化体积（fibrotic lung volume，FLV）占肺总体积（total lung volume，TLV）的百分比（简称CT_FLV/TLV%）是否可预测特发性肺纤维化（idiopathic pulmonary fibrosis，IPF）患者的预后。方法 纳入复旦大学附属中山医院2012年3月1日—7月31明确诊断为IPF的患者。记录患者一般情况、肺功能参数、圣乔治评分、GAP评分、氧饱和度和CT_FLV/TLV%等，分析各指标对患者生存期的影响。患者随访至2020年7月31日。结果 共纳入10例IPF患者，最长随访时间96个月，最短5个月，平均37.3个月。CT_FLV/TLV%与患者预后密切相关，CT_FLV/TLV%≤15的患者较CT _FLV/TLV%>15的患者具有明显的生存优势，两组差异有统计学意义（t=-2.93，P<0.05）。基线一氧化碳弥散量占预计值百分比（percentage of carbon monoxide diffusing capacity in the predicted value，DLCO% pred）与患者预后呈正相关（r=0.690，P=0.026）。基线GAP评分与生存有负相关趋势，但差异无统计学意义。用力肺活量（forced vital capacity，FVC）和用力肺活量占预计值百分比（percentage of FVC in the predicted value，FVC% pred）与患者预后无明显相关性。结论 采用3D-CT估算CT_FLV/TLV%可初步预测IPF患者预后；CT _FLV/TLV%或可预测IPF患者的生存期。

Fibrotic lung volume evaluated by 3D quantitative chest CT in predicting the survival of patients with idiopathic pulmonary fibrosis

Objective To investigate whether the percentage of fibrotic lung volume (FLV) in total lung volume (TLV),i.e.,CT_FLV/TLV% assessed by three-dimensional (3D) chest CT can predict the prognosis of patients with idiopathic pulmonary fibrosis (IPF). Methods Patients diagnosed with IPF in Zhongshan Hospital,Fudan University from Mar 1 to Jul 31,2012 were recruited. Clinical characteristics,lung function,St.George's score (SGRQ),GAP score,oxygen saturation and FLV/TLV% estimated by 3D-chest CT were recorded.All the patients were followed up until Jul 31,2020. Results A total of 10 IPF patients were enrolled.The follow-up period was 96 months at most and 5 months at least,with the mean of 37.3 months.FLV/TLV% was closely correlated with the prognosis of patients with IPF.Patients with CT_FLV/TLV% ≤ 15 had a clear survival advantage compared with those with CT_FLV/TLV%>15,and there was a significant difference between the two groups (t=-2.93,P<0.05).The baseline DLCO%pred (percentage of carbon monoxide diffusing capacity in the predicted value) had a positive correlation with the survival (r=0.690,P=0.026).The baseline GAP score had a trend of negative correlation with the survival,however,no statistical difference was found.There was no significant correlation between forced vital capacity (FVC),percentage of FVC in the predicted value (FVC%pred) and the patient's prognosis. Conclusion CT_FLV/TLV% estimated by 3D chest CT could preliminarily predict the prognosis of patients with IPF.CT _FLV/TLV% may predict the survival of IPF patients.