本文選題：COPD + 支氣管�。� 參考：《第二軍醫(yī)大學(xué)》2013年碩士論文

【摘要】：【研究背景】慢性阻塞性肺疾�。–hronic Obstruction Pulmonary Disease，COPD）是一種以不可逆氣流受限為特征的肺部疾病，缺氧與慢性炎癥是其病程的重要特征。缺氧與慢性炎癥的過(guò)程與COPD患者的氣道結(jié)構(gòu)重建及血管結(jié)構(gòu)重建密切相關(guān)，兩者相互促進(jìn)。支氣管動(dòng)脈作為肺支架結(jié)構(gòu)的營(yíng)養(yǎng)動(dòng)脈，在COPD的病程中，由于肺循環(huán)受損，肺實(shí)質(zhì)損傷及炎癥與缺氧對(duì)血管的直接刺激，會(huì)發(fā)生相應(yīng)改變。探索COPD患者的支氣管動(dòng)脈改變，為我們研究COPD患者相應(yīng)并發(fā)癥的發(fā)生提供了相關(guān)信息，也為以COPD為背景肺的其他相關(guān)疾病的研究拓寬了思路。 COPD支氣管動(dòng)脈解剖CTA研究 【目的】對(duì)COPD支氣管動(dòng)脈的解剖學(xué)特點(diǎn)進(jìn)行研究，了解COPD患者支氣管動(dòng)脈的解剖學(xué)變化特征�！痉椒ā抗彩占R床及肺功能檢查確診為COPD的患者46例，依據(jù)GOLD國(guó)際指南標(biāo)準(zhǔn)將研究對(duì)象分為GOLD1~4級(jí)，并收集患者肺功能檢查結(jié)果及一般資料。每名患者均Philips Brilliance256iCT進(jìn)行支氣管動(dòng)脈CTA檢查，對(duì)原始圖像進(jìn)行0.625mm薄層重建后傳至后處理工作站(Extended BrillianceWorkspace TM, PHILIPS)進(jìn)行后處理。利用多平面重建（MPR）、最大密度投影（MIP）及容積重建（VR）等方法對(duì)患者支氣管動(dòng)脈三維重建，評(píng)價(jià)支氣管動(dòng)脈的起源位置，起源方式、起源象限，以及支氣管動(dòng)脈的分布方式，并對(duì)重度及極重度(GOLD3~4級(jí)) COPD患者的支氣管動(dòng)脈特點(diǎn)進(jìn)行深入分析。【結(jié)果】全部46例患者共收集支氣管動(dòng)脈118支，右支氣管動(dòng)脈76支（64.41%），1.67支/例；左支氣管動(dòng)脈42支（35.59%），0.92支/例。按照左右支氣管動(dòng)脈分布分型，共觀察9種左右支氣管動(dòng)脈分型，其中以R2L1(15例)分型最多見(jiàn)，其次為R1L1（8例）。右支氣管動(dòng)脈主要起源于降主動(dòng)脈T5~6水平（64支，84.21%），起源方式包括獨(dú)立起源（27支，35.53%），多支支氣管動(dòng)脈共干起源（CTB）（25支，32.90%）及與肋間動(dòng)脈共干起源（IBT）（24支，31.58%）三種，其中包括2支共干起源于鎖骨下動(dòng)脈。起源于主動(dòng)脈的右支氣管動(dòng)脈，最常見(jiàn)的起源象限為主動(dòng)脈前內(nèi)側(cè)壁（AM）（32例），其次為內(nèi)側(cè)壁（M）（19例）和前壁（A）（18例）。左支氣管動(dòng)脈主要起源于降主動(dòng)脈T5~6水平的36支（85.72%），起源方式包括獨(dú)立起源（20支，47.62%），CTB起源（22支，52.38%）。起源于主動(dòng)脈的左支氣管動(dòng)脈，最常見(jiàn)的起源象限為前壁(A)（27例），其次為前外側(cè)壁（AL）（7例）。重度及極重度COPD患者(GOLD3~4級(jí))共25人（GOLD3~4級(jí)），共收集支氣管動(dòng)脈74支，包括右支氣管動(dòng)脈46支(62.7%)，左支氣管動(dòng)脈28支（37.3）%，1.12支/例。最常見(jiàn)的分布方式為R2L1。起源水平以降主動(dòng)脈T5~6水平最多見(jiàn)（右側(cè)：41支，89.13%；左側(cè)：24支，85.72%)。起源方式以CTB最多（右側(cè)：19支，41.31%；左側(cè)：13支，46.43%）。結(jié)論支氣管動(dòng)脈的起源動(dòng)脈、起源位置及分布，支氣管動(dòng)脈分支分布的變異都很大。COPD患者的因肺部長(zhǎng)期的缺氧與慢性炎癥影響，支氣管動(dòng)脈在解剖學(xué)也有一定特征，支氣管動(dòng)脈的支數(shù)增多，共干起源的支氣管動(dòng)脈增多。尤其在重度及極重度COPD患者中，左支氣管動(dòng)脈的顯示計(jì)數(shù)增多，，以CTB發(fā)出支氣管動(dòng)脈比例增高，是COPD患者支氣管動(dòng)脈解剖的特征體現(xiàn)。 CT血管成像對(duì)COPD支氣管動(dòng)脈形態(tài)變化的研究 【目的】探討慢性阻塞性肺疾病的支氣管動(dòng)脈在CTA表現(xiàn)上的改變�！静牧吓c方法】共收集43例結(jié)合臨床病史及肺功能檢查診斷為COPD的患者，按GOLD指南將研究對(duì)象分為四組（GOLD1級(jí)，GOLD2級(jí)，GOLD3級(jí)，GOLD4級(jí)），并收集健康體檢者10例為正常對(duì)照組。收集所有研究對(duì)象對(duì)的一般資料及肺功能檢查結(jié)果待用。利用Philips Brilliance256ict對(duì)所有患者進(jìn)行支氣管動(dòng)脈CTA檢查，將原始數(shù)據(jù)0.625mm薄層重建后，傳至工作站(Extended Brilliance Workspace TM, PHILIPS)進(jìn)行圖像后處理，利用多平面重建（MPR）、最大密度投影（MIP）及容積重建（VR）方法進(jìn)行支氣管動(dòng)脈三維重建。統(tǒng)計(jì)支氣管動(dòng)脈數(shù)，評(píng)價(jià)橫斷面圖像中縱隔內(nèi)支氣管動(dòng)脈斷面的特點(diǎn)，在MPR及VR圖像上分析支氣管動(dòng)脈形態(tài)變化情況，并比較各組間差異及各組與對(duì)照組的差異�！窘Y(jié)果】 GOLD2~4級(jí)的主干計(jì)數(shù)較對(duì)照組顯著提高（P0.05）（GOLD2與對(duì)照組：P=0.036，GOLD3與對(duì)照組：P=0.018，GOLD4與對(duì)照組P=0.002）。GOLD3~4支氣管動(dòng)脈分支計(jì)數(shù)增高（GOLD3與對(duì)照組：P=0.003，GOLD4與對(duì)照組：P=0.001）。GOLD3~4級(jí)較對(duì)照組橫斷面縱隔內(nèi)小血管斷面顯著增多(GOLD3與對(duì)照組：P=0.030，GOLD4與對(duì)照組：P=0.000)。GOLD4級(jí)較對(duì)照組支氣管動(dòng)脈走形顯著迂曲(P=0.029)，GOLD3~4級(jí)中支氣管動(dòng)脈發(fā)生扭曲成團(tuán)/簇的出現(xiàn)率顯著高于對(duì)照組（GOLD3與對(duì)照組：P=0.04，GOLD4與對(duì)照組：P=0.002）。支氣管動(dòng)脈管徑伴隨GOLD級(jí)別增高而增粗�！窘Y(jié)論】COPD的長(zhǎng)期慢性炎癥會(huì)導(dǎo)致支氣管動(dòng)脈在CTA上計(jì)數(shù)增多，形態(tài)迂曲，管徑增粗。這有可能會(huì)導(dǎo)致COPD相關(guān)并發(fā)癥的發(fā)生。 CT血管成像對(duì)COPD支氣管動(dòng)脈變化與肺功能關(guān)系的研究 【目的】利用CTA對(duì)COPD支氣管動(dòng)脈的顯示及支氣管動(dòng)脈管徑與肺功能(PFT)指標(biāo)間的關(guān)系，探索COPD支氣管動(dòng)脈變化與氣道重建的關(guān)系�！静牧吓c方法】共收集COPD患者43例，收集患者一般資料集分功能檢查結(jié)果。所有病例均接受支氣管動(dòng)脈CTA檢查（Philips，Brilliance256ict），將原始數(shù)據(jù)0.625mm薄層重建后，傳至后處理工作站(Extended Brilliance Workspace TM, PHILIPS)，利用多平面重建（MPR）、最大密度投影（MIP）及容積重建（VR）對(duì)患者支氣管動(dòng)脈重建，統(tǒng)計(jì)支氣管動(dòng)脈支數(shù)，評(píng)價(jià)支氣管動(dòng)脈的顯示情況，測(cè)量肺門(mén)水平各支支氣管動(dòng)脈管徑，并分析支氣管動(dòng)脈管徑與肺功能指標(biāo)（FEV1，F(xiàn)EV1%，F(xiàn)VC，F(xiàn)EV1/FVC）的關(guān)系�！窘Y(jié)果】共顯示支氣管動(dòng)脈102支。左支氣管動(dòng)脈41支（40.2%），平均管徑1.51mm。右支氣管動(dòng)脈61支（59.8%），平均管徑1.98mm。右支氣管動(dòng)脈管徑較左側(cè)粗，具有統(tǒng)計(jì)學(xué)意義（P=0.001）。右支氣管動(dòng)脈管徑與FEV1(r=-0.468，P=0.000)、FEV1%(r=-0.476，P=0.000)、FVC（r=-0.381，P=0.002）、FEV1/FVC(r=-0.468，P=0.000)均呈負(fù)相關(guān)。左支氣管動(dòng)脈管徑與FEV1（r=-0.314，P=0.046）、FEV1%（r=-0.357，P=0.022）呈負(fù)相關(guān)，與FVC（r=-0.265，P=0.094）及FEV1/FVC(r=-0.284，P=0.072)無(wú)顯著相關(guān)性。【結(jié)論】 CTA可清晰顯示COPD患者支氣管動(dòng)脈。右支氣管動(dòng)脈管徑較左側(cè)粗。右支氣管動(dòng)脈管徑均與肺功能指標(biāo)呈負(fù)相關(guān)。左支氣管動(dòng)脈管徑與FEV1、FEV1/預(yù)呈負(fù)相關(guān)，說(shuō)明支氣管動(dòng)脈與COPD的氣道結(jié)構(gòu)重構(gòu)關(guān)系密切。
[Abstract]:[background] chronic obstructive pulmonary disease (Chronic Obstruction Pulmonary Disease, COPD) is a pulmonary disease characterized by irreversible airflow limitation. Hypoxia and chronic inflammation are an important feature of the course of the disease. The process of hypoxia and chronic inflammation is closely related to the reconstruction of airway structure and the reconstruction of vascular structure in COPD patients. Mutual promotion. The bronchial artery is the nutrient artery of the lung stenting structure. In the course of COPD, the damage of the pulmonary circulation, the injury of the lung parenchyma, the direct stimulation of the inflammation and anoxia on the blood vessels will change accordingly. To explore the changes in the bronchial arteries of the patients with COPD, the relevant information is provided for the study of the corresponding complications of the COPD patients. It also broadens the thinking for the study of other related diseases based on COPD.
CTA study of COPD bronchial artery anatomy
[Objective] to study the anatomical features of the COPD bronchial artery and to understand the characteristics of the anatomical changes of the bronchial arteries in the patients with COPD. [Methods] 46 patients with COPD were collected from the clinical and pulmonary function examination. The subjects were divided into GOLD1~4 grade according to the international standard of GOLD, and the results of the pulmonary function examination were collected and the general results were collected. Data. The bronchial artery CTA examination was performed in each patient with Philips Brilliance256iCT, and the original images were transferred to the postprocessing workstation after 0.625mm TLC reconstruction (Extended BrillianceWorkspace TM, PHILIPS) for post-processing. The patients' bronchus was treated with the methods of multiplanar reconstruction (MPR), maximum density projection (MIP) and volume reconstruction (VR). Three-dimensional reconstruction of the arteries was used to evaluate the origin, origin, origin, quadrant, and distribution of bronchial arteries, and to analyze the characteristics of bronchial arteries in severe and extremely severe (GOLD3~4) COPD patients. [results] total of 118 bronchial arteries were collected in all 46 cases and 76 branches of right bronchial artery (64.41% 1.67 branches / cases, 42 branches of left bronchial artery (35.59%), 0.92 branches / cases. According to the distribution of the left and right bronchial arteries, 9 types of bronchial artery types were observed. Among them, R2L1 (15 cases) was the most common, followed by R1L1 (8). The right bronchial artery originated from the T5~6 level of the descending aorta (64, 84.21%), and the origin of the origin included independent origin (2 7, 35.53%) multiple bronchial artery common stem origin (CTB) (25, 32.90%) and intercostal artery co stem origin (IBT) (24, 31.58%) three species, including 2 branches originating from the subclavian artery. The right bronchial artery originated from the aorta, the most common source quadrant was the anterior medial wall of the aorta (32 cases), and the next to the medial wall (19) (19 cases). The anterior wall (A) (18 cases). The left bronchial artery originated mainly from 36 (85.72%) of the T5~6 level of the descending aorta. The origin of the origin included independent origin (20, 47.62%), CTB origin (22, 52.38%). The origin of the left tracheal artery of the aorta was the most common quadrant of the anterior wall (27), and the second (AL) (7). Severe and extremely severe COPD patients. A total of 25 people (grade GOLD3~4) (grade GOLD3~4) collected 74 bronchial arteries, including 46 branches of right bronchial artery (62.7%), 28 branch of left bronchial artery (37.3)%, 1.12 / cases. The most common distribution pattern was R2L1. origin at the T5~6 level of descending aorta (right side: 41, 89.13%; 24, 85.72%). The way of origin was CTB (CTB) most. Right: 19, 41.31%, left: 13, 46.43%. Conclusion the origin of the bronchial artery, the location and distribution of the origin and distribution of the bronchial artery branch distribution of a large.COPD patients with long-term hypoxia and chronic inflammation of the lung, the bronchial artery in the anatomy also has certain characteristics, the number of bronchial arteries increased, a total of dry up. In the severe and extremely severe COPD patients, the number of the left bronchial arteries increased and the proportion of the bronchial arteries emanate with CTB, which was the feature of the bronchial artery anatomy of the patients with COPD.
Morphological changes of bronchial arteries in COPD with CT angiography
[Objective] to investigate the changes in the CTA performance of the bronchial arteries in chronic obstructive pulmonary disease. [materials and methods] 43 patients with COPD, combined with clinical history and lung function examination, were divided into four groups according to the GOLD Guide (GOLD1, GOLD2, GOLD3, GOLD4), and 10 healthy persons were collected as normal pairs. The general data of all the subjects and the results of pulmonary function examination were collected. Philips Brilliance256ict was used to examine all patients with bronchial artery CTA. After the original data of 0.625mm thin layers were rebuilt, the images were sent to the workstation (Extended Brilliance Workspace TM, PHILIPS) for image post-processing, and multiplanar reconstruction (MPR) was used. The three-dimensional reconstruction of bronchial artery was performed by the maximum density projection (MIP) and the volume reconstruction (VR) method. The number of bronchial arteries was counted, the characteristics of the internal bronchial artery section in the mediastinum were evaluated. The morphological changes of the bronchial arteries were analyzed on the MPR and VR images, and the differences between the groups and the control groups were compared. [results] The count of GOLD2~4 level was significantly higher than that of the control group (P0.05) (GOLD2 and control group: P=0.036, GOLD3 and control group: P=0.018, GOLD4 and control group P=0.002) the.GOLD3~4 bronchial artery branch count increased (GOLD3 and control group: P=0.003, GOLD4 and control group) The increase (GOLD3 and control group: P=0.030, GOLD4 and control group: P=0.000).GOLD4 was significantly higher than that of the control group (P=0.029). The incidence of twisted group / cluster in the middle bronchial artery in GOLD3~4 was significantly higher than that of the control group (GOLD3 and control group: P=0.04, GOLD4 and control group: P=0.002). The bronchial artery diameter accompanied GO [Conclusion] chronic chronic inflammation of COPD can lead to increased number of bronchial arteries in CTA, tortuous morphology and thickening of the diameter of the tube. This may lead to the occurrence of COPD related complications.
Relationship between COPD bronchial artery changes and pulmonary function by CT angiography
[Objective] to explore the relationship between the display of COPD bronchial artery and the relationship between the bronchial artery diameter and the index of pulmonary function (PFT), to explore the relationship between the changes of the bronchial artery and the airway reconstruction of the COPD. [materials and methods] 43 patients with COPD were collected, and the results of the general data collection work were collected. All cases received bronchial arteries. CTA examination (Philips, Brilliance256ict), after the reconstruction of the original data 0.625mm thin layer, passed to the post processing workstation (Extended Brilliance Workspace TM, PHILIPS), using multiplanar reconstruction (MPR), maximum density projection (MIP) and volume reconstruction (VR) to reconstruct the artery of the trachea of the patient, to count the bronchial artery branches, and to evaluate the bronchial artery. The relationship between the bronchial arterial diameter of the bronchi and the bronchial artery diameter was measured, and the relationship between the bronchial artery diameter and the pulmonary function index (FEV1, FEV1%, FVC, FEV1/FVC) was analyzed. [results] 102 branches of the bronchial artery, 41 branches of the left bronchial artery (40.2%), the average diameter of the right bronchial artery 61 branches (59.8%), and the mean diameter of the right bronchial artery were found. The diameter of the pulse tube was larger than that of the left side (P=0.001). The diameter of the right bronchial artery was negatively correlated with FEV1 (r=-0.468, P=0.000), FEV1% (r=-0.476, P=0.000), FVC (r=-0.381, P=0.002), FEV1/FVC (r=-0.468). 4) and FEV1/FVC (r=-0.284, P=0.072) without significant correlation. [Conclusion] CTA can clearly show the bronchial artery in the patients with COPD. The right bronchial artery diameter is larger than that of the left side. The right bronchial artery diameter is negatively correlated with the lung function. The left bronchial artery diameter is negatively correlated with FEV1 and FEV1/, indicating the airway structure of the bronchial artery and COPD. The relationship of reconstruction is close.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R563.9;R816.41

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 徐秋貞;王鐘江;居勝紅;吳e

本文編號(hào)：1834737