本文選題：CT + GOD��； 參考：《中國實用內(nèi)科雜志》2014年S1期

【摘要】：目的探討Goddard評分CT分級與常規(guī)肺功能評價指標相比,對于判定肺氣腫型慢性阻塞性肺疾病(COPD)的病情嚴重程度的臨床價值;對肺氣腫表型COPD以及非肺氣腫COPD患者在上一年的住院情況以及病情嚴重程度進行評估,并對Goddard評分不同CT分級的患者在上一年的住院情況進行評估,根據(jù)研究結(jié)果對患者進行預后。方法對2012年2月~2013年2月于本院收治的肺氣腫患者80例,采用德國Siemens Difinition 64層螺旋CT機對患者進行掃描,采用Goddard評分法對患者肺部功能進行評分分級,對所有患者的FEV1、FVC、FEV1/FVC、RV、TLC、RV/TLC、DLCO、FEV1%預計值、FVC預計值以及DLCO預計值等進行測量,對Goddard評分與肺功能指標的相關(guān)性進行檢驗;對2012年2月~2013年2月于本院收治的肺氣腫表型COPD患者150例和150例非肺氣腫表型COPD患者在上一年的住院次數(shù)、住院時間、病情嚴重程度、合并癥、病死率等進行比較,對肺氣腫表型COPD Goddard評分不同分級患者在上一年的住院情況、合并癥等進行比較,從而對患者的疾病進行預后。結(jié)果 80例患者的肺部CT表現(xiàn)包括全小葉型肺氣腫34例,小葉中心型肺氣腫26例,小葉間隔旁型肺氣腫17例和疤痕旁型或不規(guī)型肺氣腫3例;Goddard評分結(jié)果顯示,輕度肺氣腫型COPD48例,中度肺氣腫型COPD 26例,重度肺氣腫型COPD 6例;CT肺功能Goddard評分與反映肺部通氣功能的RV、TLC、RV/TLC顯著相關(guān),(r=0.385,0.349,0.455,P0.05),與反映肺部彌散功能的DLCO和DLCO預計值亦顯著相關(guān)(r=0.771,0.787,P0.05);肺氣腫型COPD患者上一年住院1次率與非肺氣腫型COPD患者相比較,差異沒有統(tǒng)計學意義,但是上一年住院2次率卻顯著高于非肺氣腫型COPD患者,差異具有統(tǒng)計學意義(P0.05);肺氣腫型COPD患者上一年的平均住院時間也顯著長于非肺氣腫型COPD,差異具有統(tǒng)計學意義(P0.05);肺氣腫型COPD中的重型AECOPD的發(fā)生率顯著高于非肺氣腫型COPD,差異具有統(tǒng)計學意義(P0.05);肺氣腫型COPD患者上一年缺血性心臟病和呼吸衰竭的發(fā)病率顯著高于非肺氣腫型COPD,差異具有統(tǒng)計學意義(P0.05);Goddard評分分級越高,患者合并心力衰竭、缺血性心臟病、惡性腫瘤以及呼吸衰竭的概率隨之升高,差異具有統(tǒng)計學意義(P0.05)。結(jié)論 Goddard評分CT分級可以作為一種新的指標用于評價肺氣腫型COPD的病情嚴重程度;肺氣腫型COPD相比較非肺氣腫型COPD更易于獲得AECOPD,Goddard評分分級越高者越易于發(fā)生AECOPD,值得臨床重視與預防。
[Abstract]:Objective to evaluate the clinical value of Goddard score in evaluating the severity of chronic obstructive pulmonary disease (COPD). The hospitalization and severity of emphysematous phenotypic COPD and non-emphysematous COPD patients in the previous year were evaluated, and the hospitalization status of the patients with different Goddard scores in the previous year were evaluated. The prognosis of the patients was evaluated based on the results of the study. Methods Eighty patients with emphysema admitted in our hospital from February 2012 to February 2013 were scanned by Siemens Difinition 64-slice spiral CT machine in Germany, and the pulmonary function was graded by Goddard scoring method. The FEV1 / FVC1 / FVCV / RV / TLCV / TLC / DLCOV 1% predicted value and DLCO predictive value of all patients were measured, and the correlation between Goddard score and pulmonary function index was tested. From February 2012 to February 2013, 150 patients with emphysema phenotype COPD and 150 patients with non-emphysematous phenotype COPD were compared in terms of hospitalization times, duration of hospitalization, severity of illness, complications, mortality and so on. The hospitalization and complications of patients with different COPD Goddard scores of emphysema phenotype in the previous year were compared, and the prognosis of the patients was evaluated. Results the CT findings of 80 patients included 34 cases of lobular emphysema, 26 cases of central lobular emphysema, 17 cases of parafilobular emphysema and 3 cases of para-scar or irregular emphysema. Mild emphysema type COPD48, moderate emphysema type COPD 26 cases, In 6 cases of severe emphysema type COPD, Goddard score of pulmonary function was significantly correlated with RV / TLC, which reflected pulmonary ventilation function, and there was a significant correlation between RV / TLC and DLCO predicted values of pulmonary diffusivity in 6 cases of severe emphysema, and the rate of hospitalization in the previous year in patients with emphysematous COPD were also significantly correlated with the predicted values of DLCO and DLCO, and the rate of hospitalization in the previous year in patients with emphysematous type COPD was significantly correlated with the rate of hospitalization in the previous year and the rate of hospitalization of the patients with emphysematous COPD. Comparison of non-emphysematous COPD patients, The difference was not statistically significant, but the rate of hospitalization twice in the previous year was significantly higher than that in non-emphysematous COPD patients. The difference was statistically significant (P 0.05), and the average hospitalization time of emphysema type COPD patients was significantly longer than that of non-emphysema type COPD (P 0.05), and the incidence of severe AECOPD in emphysema type COPD was significantly higher than that in non-emphysema type COPD. The incidence of ischemic heart disease and respiratory failure in patients with emphysematous COPD in the previous year was significantly higher than that in non-emphysematous type. The incidence of heart failure, ischemic heart disease, malignant tumor and respiratory failure increased with statistically significant difference (P 0.05). Conclusion CT grading of Goddard can be used as a new index to evaluate the severity of emphysematous COPD. Compared with non-emphysematous COPD, the higher the grade of COPD is, the more likely it is to develop AECOPDD, which is worthy of clinical attention and prevention.
【作者單位】： 中南大學湘雅醫(yī)院;
【分類號】：R563.9
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本文編號：1941759