目的 用定量CT测量肺解剖容积联合肺功能检测分析肺复张形态和肺功能相关性及其影响因素。 方法 本试验是单中心回顾性研究。纳入符合标准的肺部术后患者，分别在术前和术后3个月使用定量CT计算肺解剖容积，同时测量肺功能指标包括FVC、FEV1和FEV1/FVC。然后分析肺容积与肺功能的相关性；根据肺复张指标，将患者分为非肺膨胀组和肺过度膨胀组，比较两组术前、术后肺容积变化和肺功能差异。 结果 共纳入40例患者，手术导致肺功能和肺容积都降低，其术前FVC (r=0.36, P=0.037 )、FEV1 （r=0.35, P=0.041）与肺容积呈正相关，术后3个月的FVC、FEV1与肺容积无显著相关 （P>0.05）。与非肺膨胀组相比较，肺过度膨胀组患者术前FEV1/FVC更低，且术后3月患者FEV1/FVC改善约5%；单因素分析表明个人吸烟史在肺过度膨胀组中更常见（P=0.045）。 结论 定量CT测量肺容积改变结合肺功能检查可用于早期识别术后肺过度膨胀形态，而吸烟史是肺肿瘤术后患者发生余肺过度膨胀的预测因素。
Abstract
Objective To analyze lung re-expansion and pulmonary function and their influencing factors by using quantitative CT and a spirometer. Methods A single-center retrospective study including post-operation patients with lung cancer was conducted. Quantitative CT was used to calculate the lung volume before operation and 3 months after operation. Respiratory function indicators including FVC, FEV1 and FEV1/FVC were estimated by a spirometer. The correlation between lung volume and pulmonary function was analyzed. According to the pulmonary expansion indicator, the patients were divided into a non-distention group and hyperdistention group. The changes of lung volume and pulmonary function before and after operation were compared. Results A total of 40 patients were included in this study. Both lung volume and pulmonary function decreased after operation. The preoperative FVC (r=0.36, P=0.037) and FEV1 (r=0.35, P=0.041) were positively correlated with lung volume, and there was no significant correlation between FVC, FEV1 and lung volume at 3 months after operation (P>0.05). Compared with the non-distension group, the preoperative FEV1/FVC of patients in the hyperdistention group was lower, and the FEV1/FVC improved by about 5% at 3 months after operation. Univariate analysis revealed that smoking history was more common in the hyperdistention group (P=0.045). Conclusions Quantitative CT measurements combined with pulmonary function tests can be used to identify early postoperative lung hyperdistention morphology. Smoking history is a predictor of postoperative hyperdistention in patients with lung cancer.
关键词
定量CT； /
/
肺容积； /
/
肺功能； /
/
肺扩张； /
/
因素
Key words
Quantitative CT; /
/
Lung volume; /
/
Pulmonary function; /
/
Lung expansion; /
/
Factors
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Hsia CC. Comparative analysis of the mechanical signals in lung development and compensatory growth[J]. Cell Tissue Res, 2017,367(3):687-705. DOI: 10.1007/s00441-016-2558-8.
[2] Smith BM, Hoffman EA, Basner RC, et al. Not all measures of hyperinflation are created equal: lung structure and clinical correlates of gas trapping and hyperexpansion in COPD: the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study [J]. Chest, 2014,145(6):1305-1315. DOI: 10.1378/chest.13-1884.
[3] Glénet S, de Bisschop C, Delcambre F, et al. No compensatory lung growth after resection in a one-year follow-up cohort of patients with lung cancer[J]. J Thorac Dis, 2017, 9(10):3938-3945. DOI: 10.21037/jtd.2017.08.135.
[4] Takahashi Y, Matsutani N, Morita S, et al. Predictors of long-term compensatory response of pulmonary function following major lung resection for non-small cell lung cancer[J]. Respirology, 2017, 22(2):364-371. DOI: 10.1111/resp.12904.
[5] Mizobuchi T, Chen F, Yoshino I, et al. Radiologic evaluation for volume and weight of remnant lung in living lung donors[J]. J Thorac Cardiovasc Surg, 2013, 146(5):1253-1258. DOI: 10.1016/j.jtcvs. 2013. 05.038.
[6] 窦郁, 卢星如, 马娴, 等. 孤立性肺实性结节和混杂磨玻璃结节对比研究[J].中国临床解剖学杂志, 2018, 36(6):657-661. DOI: 10.13418/j.issn.1001-165x.2018.06.012.
[7] Shikuma K, Chen-Yoshikawa TF, Oguma T, et al. Radiologic and functional analysis of compensatory lung growth after living-donor lobectomy[J]. Ann Thorac Surg, 2018, 105(3):909-914. DOI: 10.1016/j.athoracsur.2017.09.060.
[8] 刘金良, 庞军, 孙志红, 等. 胸部CT定量技术对慢性阻塞性肺疾病病人心肺功能的评估价值[J].蚌埠医学院学报, 2021, 46(3):382-387. DOI: 10.13898/j.cnki.issn.1000-2200.2021.03.028.
[9] Robbie H, Wells AU, Jacob J, et al. Visual and automated CT measurements of lung volume loss in idiopathic pulmonary fibrosis[J]. Am J Roentgenol, 2019, 213(2):318-324. DOI: 10.2214/AJR.18.20884.
[10] Caragounis EC, Fagevik Olsén M, Granhed H, et al. CT-lung volume estimates in trauma patients undergoing stabilizing surgery for flail chest[J]. Injury, 2019,50(1):101-108. DOI: 10.1016/j.injury. 2018. 10.016.
[11] Chen F, Kubo T, Shoji T, et al. Comparison of pulmonary function test and computed tomography volumetry in living lung donors[J]. J Heart Lung Transplant,2011,30(5):572-575. DOI: 10.1016/j.healun. 2010. 11.019.
[12] Murakami J, Ueda K, Hayashi M, et al. Size-capacity mismatch in the lung: a novel predictor for complications after lung cancer surgery[J]. J Surg Res, 2017, 209:131-138. DOI: 10.1016/j.jss.2016.08.051.
[13] ad hoc Statement Committee, American Thoracic Society. Mechanisms and limits of induced postnatal lung growth[J]. Am J Respir Crit Care Med, 2004,170(3):319-343. DOI: 10.1164/rccm.200209-1062ST.
[14] Butler JP, Loring SH, Patz S, et al. Evidence for adult lung growth in humans[J]. N Engl J Med, 2012, 367(3):244-247. DOI: 10.1056/NEJMoa1203983.
[15] Wakamatsu I, Matsuguma H, Nakahara R, et al. Factors associated with compensatory lung growth after pulmonary lobectomy for lung malignancy: an analysis of lung weight and lung volume changes based on computed tomography findings[J]. Surg Today, 2020, 50(2):144-152. DOI: 10.1007/s00595-019-01863-0.
[16] Ueda K, Murakami J, Sano F, et al. Assessment of volume reduction effect after lung lobectomy for cancer[J]. J Surg Res, 2015, 197(1):176-182. DOI: 10.1016/j.jss.2015.03.064.
基金
国家自然科学基金（No. 81972142， No. 81871857）
PDF(3349 KB)
京ICP备08002354号-3
