本文選題：肺疾病　切入點：慢性阻塞性　出處：《廣州醫(yī)學(xué)院》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討HRCT評價COPD的方法，根據(jù)影像學(xué)表現(xiàn)及對COPD進行HRCT分型，研究COPD各型與肺功能、臨床特征的關(guān)系。 材料與方法：收集2009年2月至2011年2月廣州醫(yī)學(xué)院第一附屬醫(yī)院廣州呼吸疾病研究所收治的108位COPD患者，其中男100例，女8例，年齡46-78歲，平均年齡（66±7）歲，經(jīng)臨床診斷，COPD患者：1級31例，2級39例，3級26例，4級12例。在最大吸氣末及最大呼氣末屏氣掃描，根據(jù)HRCT影像表現(xiàn)、支氣管管壁增厚情況及CT肺功能定量檢查肺氣腫程度進行分型。 結(jié)果：根據(jù)支氣管管壁增厚程度及肺氣腫程度，將COPD患者分為5種類型：（1）A型28例，無或輕度肺氣腫，17例未合并管壁增厚，11例合并支氣管管壁增厚；（2）M1型19例，存在中度肺氣腫及支氣管管壁增厚；（3）M2型12例，存在重度或極重度肺氣腫和支氣管管壁增厚；（4）E1型35例，有中度肺氣腫，無支氣管管壁增厚；（5）E2型14例，有重度或極重度肺氣腫，無支氣管管壁增厚。A型、E1型患者的體重指數(shù)分別為（23.0±1.9，23.4±3.3）kg/m2，高于E2型、M1型、M2型（19.3±3.6，22.6±3.0，20.0±2.4）kg/m2，各型間差異有統(tǒng)計學(xué)意義（F=7.679，P＜0.01）。不同CT分型中吸煙指數(shù)差異無統(tǒng)計學(xué)意義，COPD臨床分級人數(shù)及近6個月急性加重頻率差異有統(tǒng)計學(xué)意義。A型患者的FEV1%、FEV1/FVC分別為（75.6±15.8）%，（62.8±8.0），均優(yōu)于其他各型，各型間差異有統(tǒng)計學(xué)意義，（F值分別為7.076和15.111，，均P＜0.01）。M2型患者的殘氣量最大，平均值為（184.8±52.1），高于其他各型，差異有統(tǒng)計學(xué)意義，（F=5.077，P＜0.05）。M2型患者的殘總比平均值為（160.9±17.6），高于其他各型，差異有統(tǒng)計學(xué)意義，（F=6.974，P＜0.01）。各型患者肺總量間的差別無統(tǒng)計學(xué)意義。在吸氣、呼氣相CT肺功能各項檢查指標(biāo)中：A型患者肺平均CT值分別為（-877.2±28.5，-761.7±25.3）HU，高于其他各型，差異有統(tǒng)計學(xué)意義，（F值分別為20.131和90.595，均P＜0.01）；E2型患者肺氣體總?cè)莘e中分別為（5618.1±961.9,4131.4±1143.6）cm3，大于其他各型，差異有統(tǒng)計學(xué)意義，（F值分別為5.933和28.691，均P＜0.01）；A型患者單位體積密度最大，分別為（0.1201±0.0217,0.2338±0.0302)g/cm3,各型間差異有統(tǒng)計學(xué)意義，（F值分別為18.931和66.108，均P＜0.01）；E2型患者肺氣腫容積分別為（4219.4±898.1，2470.3±1191.9）cm3，高于其他各型，差異有統(tǒng)計學(xué)意義，（F值分別為20.120和71.347，均P＜0.01）。 結(jié)論：通過HRCT和CT肺功能檢查能將COPD分為5種類型，各類型的臨床特征、常規(guī)肺功能、CT肺功能各項指標(biāo)不同，對臨床進一步的個體化治療有積極的指導(dǎo)意義。
[Abstract]:Objective: to study the relationship between HRCT and pulmonary function and clinical features according to the imaging findings and HRCT classification of COPD. Materials and methods: from February 2009 to February 2011, 108 patients with COPD were collected from Guangzhou Institute of Respiratory Diseases, the first affiliated Hospital of Guangzhou Medical College, including 100 males and 8 females, aged 46 to 78 years, with an average age of 66 鹵7 years. According to the clinical diagnosis, 31 cases with grade 1, 39 cases with grade 2 and 39 cases with grade 3 with grade 3 or grade 4 were clinically diagnosed. Breath holding at the maximum inspiratory and expiratory end was performed in 12 cases. According to the HRCT findings, Bronchial wall thickening and CT quantitative examination of pulmonary function were used to type emphysema. Results: according to the degree of bronchial wall thickening and emphysema, the patients with COPD were divided into 5 types: 28 cases of type 1: 1 A, 17 cases of no or mild emphysema without thickening of bronchial wall and 11 cases of type M 1 with thickening of bronchial wall. There were 12 cases of moderate emphysema and thickening of bronchial wall, 35 cases of severe or extremely severe emphysema and thickening of bronchial wall, 35 cases of type E 1, moderate emphysema, 14 cases of type E 2 without thickening of bronchial wall, and 14 cases of severe or very severe emphysema. The BMI of patients without thickening of bronchial wall. A type E 1 was 23.0 鹵1.9 鹵23.4 鹵3.3 kg / m 2, which was higher than that of E2 type M 1 M 1 M 2 (19.3 鹵3.6N 22.6 鹵3.0 鹵2.4 kg / m 2). There was a significant difference between the two types (P < 0.01). There was no significant difference in the number of COPD patients and the number of COPD patients in different CT classification. There were significant differences in the frequency of acute exacerbation in the last 6 months. The FEV1 / FVC of FEV1 / FEV1 / FVC in patients with type A was 75.6 鹵15.8% and 62.8 鹵8.0%, respectively, which was superior to other types. There were significant differences in F values between different types (7.076 and 15.111, respectively, P < 0.01). The mean value of residual gas in patients with type M2 was 184.8 鹵52.1, which was higher than that of other types. The difference was statistically significant (P < 0.05). The average of total residual ratio of patients with type M2 was 160.9 鹵17.6g, which was higher than that of other types. The difference was statistically significant (P < 0.01). There was no significant difference in the total lung volume among the patients with different types of pulmonary function. The average CT values of lung in patients with type A of inspiratory and expiratory CT were -877.2 鹵28.5- 761.7 鹵25.3, respectively, which were higher than those of other types. There were significant differences in F values (20.131 and 90.595, respectively, P < 0.01). The total volume of lung gas in patients with E2 was 5618.1 鹵961.9 鹵1143.6 cm ~ (3), which was higher than that of other types, and the F values were 5.933 and 28.691, respectively (P < 0.01). It was 0.1201 鹵0.0217U 0.2338 鹵0.0302g / cm ~ 3 respectively. The F values of the patients with E _ 2 were 18.931 and 66.108, respectively (P < 0.01). The volume of emphysema was 4219.4 鹵898.1 鹵2470.3 鹵1191.9 cm ~ (3), which was higher than that of other types (20.120 and 71.347, respectively, P < 0.01). Conclusion: COPD can be divided into five types by HRCT and CT pulmonary function examination. The clinical characteristics of each type and the indexes of CT pulmonary function of routine pulmonary function are different, which has positive guiding significance for further individualized clinical treatment.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R563.9

【參考文獻】

相關(guān)期刊論文 前10條

1 駱仙芳,沈華浩;慢性阻塞性肺疾病與肺血管系統(tǒng)[J];國外醫(yī)學(xué).呼吸系統(tǒng)分冊;2005年06期

2 李一鳴,祁吉;慢性阻塞性肺疾病的CT研究進展[J];國外醫(yī)學(xué)(臨床放射學(xué)分冊);2005年01期

3 葉菁;劍鞘氣管與慢性阻塞性肺疾病的關(guān)系[J];臨床放射學(xué)雜志;2000年02期

4 牡丹;劉白鷺;;肺功能的影像學(xué)研究進展及臨床應(yīng)用[J];臨床放射學(xué)雜志;2006年02期

5 趙亞春;賀文;;慢性阻塞性肺疾病的HRCT形態(tài)學(xué)表現(xiàn)及分型與肺功能的相關(guān)分析[J];臨床放射學(xué)雜志;2009年02期

6 高秀華;蔣超英;;慢性阻塞性肺疾病合并肺栓塞10例分析[J];臨床誤診誤治;2008年02期

7 陳東良;沈健;濮曉霞;徐亞熙;馬曉亮;方少華;;慢性阻塞性肺疾病的病理基礎(chǔ)與HRCT的對比研究[J];醫(yī)學(xué)影像學(xué)雜志;2007年04期

8 ;慢性阻塞性肺疾病診治指南[J];中華結(jié)核和呼吸雜志;2002年08期

9 陳曄;蔡宛如;;慢性阻塞性肺疾病氣道重構(gòu)研究進展[J];浙江中西醫(yī)結(jié)合雜志;2009年08期

10 陳淮;曾慶思;關(guān)玉寶;高怡;鄭勁平;侯欣然;;多層螺旋CT定量成像技術(shù)肺部參數(shù)應(yīng)用[J];中國醫(yī)學(xué)影像技術(shù);2010年02期

本文編號：1579415