哮喘与慢性阻塞性肺疾病支气管改变的HRCT定量-第三军医大学学报.doc

哮喘与慢性阻塞性肺疾病支气管改变的HRCT定量研究 张旭升1，邹利光1，白 莉2，张 松1，王长征2，梁开运1 （400037 重庆，第三军医大学新桥医院：放射科1，呼吸科2） [摘要] 目的 通过对哮喘和慢性阻塞性肺疾病（COPD）患者胸部高分辨率CT（high resolution computed tomography, HRCT）扫描，探讨哮喘和COPD患者段和亚段支气管重塑的差异。方法 哮喘34例，COPD32例，正常对照24例，胸部HRCT扫描，对双上肺尖段及亚段、双下肺后基底段及亚段支气管进行描述性观察和定量分析，采用支气管自动分析软件Thoracic VCAR分别测量4支段和亚段支气管的壁厚度（wall thickness, WT）、腔内径（inner diameter, Din）、壁面积（wall area, WA）和壁面积百分比（WA%），并计算平均值，分析3组间各指标的差异。结果 哮喘和COPD患者支气管改变表现为支气管壁增厚和管腔变窄。段支气管各参数的组间比较，哮喘患者WT大于正常对照（P0. 05），但哮喘和COPD比较无显著性差异（P＞0. 05）；哮喘患者Din最小，COPD次之，正常对照最大（P0. 05）；WA各组间无显著性差异（P＞0. 05）；哮喘患者WA%最大，COPD次之，正常对照最小（P0. 05）。亚段支气管各参数的组间比较，COPD患者WT最大，哮喘次之，正常对照最小（P0. 05）；COPD患者Din最小，哮喘次之，正常对照最大（P0. 05）；COPD患者WA较正常和哮喘大（P0. 05）；COPD患者WA%最大，哮喘次之，正常对照最小（P0. 05）。结论 哮喘和COPD患者有不同程度的支气管重塑，表现为支气管壁增厚和管腔变窄，哮喘患者的气道重构在段和亚段支气管均较明显，COPD患者的气道重构在亚段支气管较明显。 [关键词] 支气管哮喘；慢性阻塞性肺疾病；高分辨率CT；气道重构 [中图法分类号] [文献标志码] A Quantitative study of bronchus changes in asthma and chronic obstructive pulmonary disease by HRCT Zhang Xusheng 1, Zou Liguang 1, Bai Li 2, Zhang Song 1, Wang Changzheng 2, Liang Kaiyun 1 ( 1 Department of Radiology, 2 Department of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China) [Abstract] Objective To investigate airway remodeling differences of segmental bronchi and sub-segmental bronchi between bronchial asthma and chronic obstructive pulmonary disease (COPD) patients by high resolution computed tomography (HRCT). Methods HRCT were performed in 34 asthmatic patients, 32 COPD patients and 24 normal subjects. CT images of segmental bronchi and sub-segmental bronchi were reviewed quantitatively and descriptively. Wall thickness (WT), inner diameter (Din), wall area (WA), percentage of wall area (WA%) of upper lobe apical segmental and sub-segmental bronchi of right and left lung, as well as lower lobe posterior basal segmental and sub-segmental bronchi of right and left lung were detected by bronchus automatic analysis software Thoracic VCAR. Th