轻度二氧化碳潴留慢性阻塞性肺疾病肺功能和CT的特征

doi:10.3877/cma.j.issn.1674-6902.2020.01.005

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (01) : 23 -27. doi: 10.3877/cma.j.issn.1674-6902.2020.01.005

论著

轻度二氧化碳潴留慢性阻塞性肺疾病肺功能和CT的特征

魏霞¹^,^†(

), 于楠², 米九运³, 任京婷³, 丁琦³, 高延忠⁴, 齐敏⁵, 郭佑民⁶

^1. 710054　西安，西安市第九医院呼吸与危重症医学科；710061　西安，西安交通大学第一附属医院放射与核医学科
^2. 712046　咸阳，陕西中医药大学影像科
^3. 710054　西安，西安市第九医院呼吸与危重症医学科
^4. 710054　西安，西安市第九医院影像科
^5. 710068　西安，陕西省人民医院影像科
^6. 710061　西安，西安交通大学第一附属医院放射与核医学科

收稿日期:2019-08-12 出版日期:2020-02-25
通信作者: 魏霞
基金资助:
2014年国家公益性行业科研专项(201402013); 陕西省社会发展科技攻关项目(2016SF-151); 西安市科技局社会发展引导计划—医学研究项目(2016045SF/YX01)

Pulmonary functions and imaging features of patients with chronic obstructive pulmonary disease combined with mild carbon dioxide retention

Xia Wei¹^,^†(), Nan Yu², Jiuyun Mi³, Jingting Ren³, Qi Ding³, Yanzhong Gao⁴, Min Qi⁵, Youmin Guo⁶

^1. Department of Medicine, Ninth People′s Hospital, Xi′an 710054, China; Department of Radiology and Nuclear Medicine, Affiliated Hospital, Xi′an Jiaotong University, Xi′an 710061, China
^2. Department of Imaging, Shaanxi University of Traditional Chinese Medicine, Xi′an 712046, China
^3. Department of Medicine, Ninth People′s Hospital, Xi′an 710054, China
^4. Department of Imaging, Ninth People′s Hospital, Xi′an 710054, China
^5. Department of Imaging, Shaanxi People′s Hospital, Xi′an 710068, China
^6. Department of Radiology and Nuclear Medicine, Affiliated Hospital, Xi′an Jiaotong University, Xi′an 710061, China

Received:2019-08-12 Published:2020-02-25
Corresponding author: Xia Wei

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引用本文：

魏霞, 于楠, 米九运, 任京婷, 丁琦, 高延忠, 齐敏, 郭佑民. 轻度二氧化碳潴留慢性阻塞性肺疾病肺功能和CT的特征[J]. 中华肺部疾病杂志(电子版), 2020, 13(01): 23-27.

Xia Wei, Nan Yu, Jiuyun Mi, Jingting Ren, Qi Ding, Yanzhong Gao, Min Qi, Youmin Guo. Pulmonary functions and imaging features of patients with chronic obstructive pulmonary disease combined with mild carbon dioxide retention[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(01): 23-27.

目的

探讨轻度CO₂潴留慢性阻塞性肺疾病人群的肺功及影像特征，为监测和治疗提供依据。

方法

选择147例慢性阻塞性肺疾病急性加重期患者，分为非CO₂潴留组61例PaCO₂＝40～44.9 mmHg；轻度CO₂潴留组48例PaCO₂＝45～50 mmHg；呼吸衰竭组38例PaCO₂>50 mmHg，比较3组在肺功能和容积CT参数的异同。

结果

轻度潴留组在肺功能参数如一秒率(FEV₁%pred)等和肺气肿参数如肺气肿平均密度(MED)、肺密度分布直方图中第15百分位点所对应的CT值(PD15)等，与呼吸衰竭组存在明显差异(P<0.05)，与非潴留组无统计学差异(P>0.05)。spearman相关分析显示PaCO₂与FEV₁%Pred、FVC%pred呈中度负相关(r分别是-0.536，-0.576，P<0.001)，与PD15和MED存在弱负相关(r＝-0.325，P＝0.002)。

结论

轻度CO₂潴留COPD肺结构和功能特征与非潴留COPD相似；呼吸衰竭组COPD具有更严重的病理和肺功能损害；CO₂轻度潴留向Ⅱ型呼吸衰竭进展中，FEV₁%pred等肺功能指标联合PD15和MED影像参数从功能和结构上能更好地反应病情。

关键词: 肺疾病, 慢性阻塞性, 二氧化碳潴留, 肺功能, 影像学

Objective

To investigate the pulmonary functions and imaging features of the patients with chronic obstructive pulmonary disease (COPD) combined with mild carbon dioxide (CO₂) retention in order to provide evidences for monitoring and treatment of this disease.

Methods

A total of 147 patients with acute exacerbation of COPD were included for this study. Sixty-one patients with the arterial carbon dioxide tension (PaCO₂) of 40-44.9 mm Hg were taken as the no-CO₂ retention group, 48 patients with PaCO₂ of 45-50 mmHg were taken as the mild CO₂ retention group, and 38 cases with PaCO₂ of more than 50 mmHg were taken as the respiratory failure group. The differences of the pulmonary functions and volume CT were compared between the three groups.

Results

In the mild CO₂ retention group, the pulmonary function parameters such as the percentage of predicted forced expiratory volume in one second (FEV₁%pred), CT value corresponding to the 15th percentile of lung density distribution (PD15) and the mean emphysema density (MED) were significantly different from those of the respiratory failure group (P<0.05). Spearman correlation analysis showed that PaCO₂ had a moderate negative correlation with FEV₁%pred and the percentage of predicted forced vital capacity (FVC%pred, r=-0.536 and -0.576, respectively, P<0.001) and a weak negative correlation with PD15 of the whole lungs (r=-0.325, P=0.002) and the MED of the whole lungs (r=-0.333, P=0.002).

Conclusion

The structure and functional characteristics of the COPD patients with mild CO₂ retention are similar to the COPD patients with no CO₂ retention. The COPD patients with PaCO₂>50 mmHg suffer from more severe pathological and pulmonary function damage. In the progression of mild CO₂ retention to type Ⅱ respiratory failure, the pulmonary function parameters combined with PD15 and MED may better reflect the disease.

Key words: Chronic obstructive pulmonary disease, Carbon dioxide retention, Pulmonary function test, CT imaging

表1 三组肺气肿参数Perc15和MED的ANOVA分析及组间结果比较

肺气肿参数	例数	PD15_全肺	PD15_右肺	PD15_左肺	PD15_右上肺	PD15_右中肺	PD15_右下肺	PD15_左上肺	PD15_左下肺
非潴留组	61	-1 007.69±4.08	-1 007.39±4.29	-1 008.05±4.21	-1 006.82±4.37	-1 007.18±5.96	-1 007.36±4.63	-1 007.72±4.37	-1 008.2±4.6
轻度潴留组	48	-1 007.06±4.47^b	-1 006.65±4.79^b	-1 007.52±4.36^b	-1 006.69±5.75^a	-1 006.85±5.3^a	-1 006.42±5.37^a	-1 007.19±4.38^b	-1 007.81±4.72^a
呼衰组	38	-1 009.97±4.65^d	-1 009.53±5.01^d	-1 010.18±4.68^d	-1 009.21±5.6^d	-1 009.45±4.59^d	-1 009.21±5.06	-1 009.89±4.68^d	-1 010.18±4.95^d
F值		5.134	4.298	4.309	3.16	2.836	3.383	4.312	3.017
P值		0.007	0.015	0.015	0.045	0.062	0.037	0.015	0.052
肺气肿参数	例数	MED_全肺	MED_右肺	MED_左肺	MED_右上肺	MED_右中肺	MED_右下肺	MED_左上肺	MED_左下肺
非潴留组	61	-982.32±2.88	-982.04±2.94	-982.62±3.04	-981.8±3.02	-965.19±126.76	-982.03±3.14	-982.36±3.16	-982.54±3.1
轻度潴留组	48	-981.92±3.15^b	-981.69±3.37^b	-982.16±3.02^b	-981.51±3.59^a	-960.87±141.67	-981.43±3.64^a	-982±3.11^b	-982.18±3.24^a
呼衰组	38	-984.03±3.18^e	-983.7±3.31^d	-984.09±3.2^d	-983.33±3.69^d	-983.17±3.31	-983.2±3.3	-983.97±3.22^d	-983.78±3.19
F值		5.603	4.761	4.442	3.452	0.44	2.999	4.636	2.945
P值		0.005	0.01	0.013	0.034	0.645	0.053	0.011	0.056

表1 三组肺气肿参数Perc15和MED的ANOVA分析及组间结果比较

肺气肿参数	例数	PD15_全肺	PD15_右肺	PD15_左肺	PD15_右上肺	PD15_右中肺	PD15_右下肺	PD15_左上肺	PD15_左下肺
非潴留组	61	-1 007.69±4.08	-1 007.39±4.29	-1 008.05±4.21	-1 006.82±4.37	-1 007.18±5.96	-1 007.36±4.63	-1 007.72±4.37	-1 008.2±4.6
轻度潴留组	48	-1 007.06±4.47^b	-1 006.65±4.79^b	-1 007.52±4.36^b	-1 006.69±5.75^a	-1 006.85±5.3^a	-1 006.42±5.37^a	-1 007.19±4.38^b	-1 007.81±4.72^a
呼衰组	38	-1 009.97±4.65^d	-1 009.53±5.01^d	-1 010.18±4.68^d	-1 009.21±5.6^d	-1 009.45±4.59^d	-1 009.21±5.06	-1 009.89±4.68^d	-1 010.18±4.95^d
F值		5.134	4.298	4.309	3.16	2.836	3.383	4.312	3.017
P值		0.007	0.015	0.015	0.045	0.062	0.037	0.015	0.052
肺气肿参数	例数	MED_全肺	MED_右肺	MED_左肺	MED_右上肺	MED_右中肺	MED_右下肺	MED_左上肺	MED_左下肺
非潴留组	61	-982.32±2.88	-982.04±2.94	-982.62±3.04	-981.8±3.02	-965.19±126.76	-982.03±3.14	-982.36±3.16	-982.54±3.1
轻度潴留组	48	-981.92±3.15^b	-981.69±3.37^b	-982.16±3.02^b	-981.51±3.59^a	-960.87±141.67	-981.43±3.64^a	-982±3.11^b	-982.18±3.24^a
呼衰组	38	-984.03±3.18^e	-983.7±3.31^d	-984.09±3.2^d	-983.33±3.69^d	-983.17±3.31	-983.2±3.3	-983.97±3.22^d	-983.78±3.19
F值		5.603	4.761	4.442	3.452	0.44	2.999	4.636	2.945
P值		0.005	0.01	0.013	0.034	0.645	0.053	0.011	0.056

图1 A、B和C图分别表示CO₂非潴留、轻度潴留和呼衰患者的容积CT肺气肿分析图，不同色彩反应不同肺叶肺气肿分布情况，软件计算的肺气肿参数(如LAA%-950、PD15和MED等)显示在图片左侧

图2 1-A和1-B显示CO₂未潴留组、轻度潴留组和呼衰组在肺功能参数MVV%pred、FEV₁%pred、FEV₁/FVC、MMEF%pred、RV/TLC和DLCO/VA组间比较差异，NS表示无统计学差异；*表示有统计学差异，P<0.05；**表示有统计学差异，P<0.01；***表示有统计学差异，P<0.001

表2 动脉CO₂分压与肺功能影像参数spearman相关性分析

肺功能	r	P值	PD15(Hu)	r	P值	MED(Hu)	相关系数	P值
MVV%pred	-0.451	<0.001	PD15_全肺	-0.325	0.002	MED_全肺	-0.333	0.002
FEV₁%	-0.536	<0.001	PD15_右肺	-0.317	0.003	MED_右肺	-0.327	0.002
FVC%Pred	-0.576	<0.001	PD15_左肺	-0.298	0.005	MED_左肺	-0.309	0.004
FEV₁/FVC	-0.273	0.011	PD15_右上肺	-0.281	0.009	MED_右上肺	-0.293	0.007
MMEF	-0.506	<0.001	PD15_右中肺	-0.305	0.004	MED_右中肺	-0.349	0.001
DLCO/VA	-0.277	0.011	PD15_右下肺	-0.288	0.007	MED_右下肺	-0.274	0.011
RV/TLC	0.386	<0.001	PD15_左上肺	-0.294	0.006	MED_左上肺	-0.308	0.004
			PD15_左下肺	-0.287	0.007	MED_左下肺	-0.295	0.006

表2 动脉CO₂分压与肺功能影像参数spearman相关性分析

肺功能	r	P值	PD15(Hu)	r	P值	MED(Hu)	相关系数	P值
MVV%pred	-0.451	<0.001	PD15_全肺	-0.325	0.002	MED_全肺	-0.333	0.002
FEV₁%	-0.536	<0.001	PD15_右肺	-0.317	0.003	MED_右肺	-0.327	0.002
FVC%Pred	-0.576	<0.001	PD15_左肺	-0.298	0.005	MED_左肺	-0.309	0.004
FEV₁/FVC	-0.273	0.011	PD15_右上肺	-0.281	0.009	MED_右上肺	-0.293	0.007
MMEF	-0.506	<0.001	PD15_右中肺	-0.305	0.004	MED_右中肺	-0.349	0.001
DLCO/VA	-0.277	0.011	PD15_右下肺	-0.288	0.007	MED_右下肺	-0.274	0.011
RV/TLC	0.386	<0.001	PD15_左上肺	-0.294	0.006	MED_左上肺	-0.308	0.004
			PD15_左下肺	-0.287	0.007	MED_左下肺	-0.295	0.006

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Pulmonary functions and imaging features of patients with chronic obstructive pulmonary disease combined with mild carbon dioxide retention

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Pulmonary functions and imaging features of patients with chronic obstructive pulmonary disease combined with mild carbon dioxide retention