【作者】 刘超武；

【导师】 林江涛；

【作者基本信息】 北京协和医学院 ， 内科学， 2011， 博士

【摘要】 研究背景振动反应成像技术(vibration response imaging, VRI)是一项由以色列学者于2005年发明的基于振动反应成像技术与计算机技术的呼吸成像技术,它可以实时的输出呼吸音图像信息并以数据表格形式反应肺部各部位呼吸音的信息。国内外已应用VRI技术进行了一些临床研究,但国内尚无应用VRI技术探讨吸烟对肺部损害影响的研究。目的通过研究健康非吸烟者的图像、常规肺功能正常的重度吸烟者及其戒烟后的VRI图像,对VRI的一些图像特征可认识性、一致性进行评估。研究健康非吸烟者、常规肺功能正常的重度吸烟者的VRI图像特点及两组VRI图像的异同,同时探讨常规肺功能正常的重度吸烟者戒烟成功持续6月以上的VRI图像特征.从而探讨VRI图像改变反应吸烟对机体的影响。方法招募60名健康非吸烟者、67名常规肺功能正常的重度吸烟者,对其进行病史询问、收集临床资料,然后进行肺功能测定、胸部X线和VRI检查,并对常规肺功能正常的重度吸烟者进行戒烟干预,对戒烟成功持续6月以上的常规肺功能正常的重度吸烟者再次进行VRI检查。最后对VRI的一些图像特征进行可认识性、一致性评估,对VRI图像分别进行能量振动曲线、动态图像特征、能量分布特征分析。结果常规肺功能正常的重度吸烟者的QLD值如下：右上肺占(7.17±2.92)%、右中肺占(14.44±4.25)%、右下肺占(21.78±5.21)%、右肺占(43.39±8.23)%；左上肺占(11.39±5.15)%、左中肺占(18.56±3.99)%、左下肺占(26.33±6.16)%、左肺占(56.61±8.23)%。常规肺功能正常的重度吸烟者的QLD值与健康非吸烟者比较有以下特征：常规肺功能正常的重度吸烟者右中肺QLD值小于健康非吸烟者的(19±4)%(P<0.05),常规肺功能正常的重度吸烟者右下肺QLD值大于健康非吸烟者的(19±4)%(P<0.05),常规肺功能正常的重度吸烟者左上肺QLD值大于健康非吸烟者的(9±2)%(P<0.05),常规肺功能正常的重度吸烟者左下肺QLD值大于健康非吸烟者的(23±5)%(P<0.05)。此外MEF能量中心数与健康非吸烟者相比存在显著性差异(P<0.05)。常规肺功能正常的重度吸烟者VRI振动能量曲线出现呼气相低平、平台、凹陷和单峰的频率分别为43.3%、16.4%、16.4%和14.9%；健康非吸烟组呼气相低平、平台的频率分别为6.7%、3.3%,凹陷、单峰均未出现,这些征象在两组间均存在显著性差异(P<0.05)。呼气相能量峰值／吸气相能量峰值比：重度吸烟组为0.56,健康非吸烟组为0.74,常规肺功能正常的重度吸烟者与健康非吸烟者相比存在显著性差异(P<0.05)。67名常规肺功能正常的重度吸烟者动态图像出现无序的11例(16.4%),出现跳跃的43例(64.2%),出现左、右肺不同步的11例(16.4%),出现延迟的6例(14.9%),健康非吸烟者动态图像出现无序的4例(6.7%),出现跳跃的2例(3.3%),不同步0例(0%),出现延迟的0例(0%),这些征象出现的频率在两组间均存在显著性差异(P<0.05)。重度吸烟者的动态图像积分为1.22±0.42高于健康非吸烟组的动态图像积分0.13±0.01(P<0.05)。11名戒烟成功持续6月以上常规肺功能正常的重度吸烟者戒烟成功6个月后VRI动态图像积分较戒烟前无显著性变化(P<0.05),而呼气相峰值／吸气能量峰值比较戒烟前有较显著的增高(P<0.05)。结论应用VRI技术能够早期发现常规功能检查正常的重度吸烟者异常肺部改变；肺功能正常的重度吸烟者VRI图像异常改变在戒烟后能部分改善。更多还原

【Abstract】 BackgroundVibration response imaging (VRI) is a new lung sound imaging technology which was invented in 2005 by an Israel scholar. It shows the vibration in the lung during respiratory period and outputs the real time information by charts or tables. Now clinical researches about VRI can been found all over the world. But no clinical report which study the VRI characters in heavy smokers whose pulmonary function is normal can be found in China up to date.ObjectiveVibration response imaging(VRI) is a new lung sound imaging technology. The study is preliminarily to explore the image properties of heavy smokers and healthy subjects. Using VRI to detect the heavy smokers with normal pulmonary function after 6 months since they stop smoking successfully and then investigate whether VRI can reflect the influence of smoking to human body.MethodsAll subjects were divided into two groups:heavy smokers whose pulmonary function is normal and healthy non-smokers. First of all, we asked their case history and did physical examination. Then we tested their lung function and checked up their chest X-ray and VRI, tested their VRI again among heavy smokers after 6 months since they stop smoking successfully. Finally, the differences of VRI dynamic imaging among the two groups were analyzed.ResultsQLD of upper right lung, middle right lung, lower right lung, right lung respectively account for (7.17±2.92)%, (14.44±4.25)%, (21.78±5.21)%, (43.39±8.23)%. QLD of upper left lung, middle left lung, lower left lung, left lung respectively account for (11.39±5.15)%, (18.56±3.99)%, (26.33±6.16)%, (56.61±8.23)%. Compared with the non-smokers,the QLD of lower right lung, upper left lung, lower left lung heavy smokers with normal pulmonary function are significantly different(P<0.05).In addition, the number of energy center of the heavy smokers with normal pulmonary function is more than non-smokers. Dynamic imaging in heavy smokers group which appeared disorder, skip, derangement, delay were separately accounted for 16.4%,64.2%,16.4%,14.9%. While in healthy non-smokers group respectively account for 6.7,3.3%,0%,0%.The results between heavy smokers whose pulmonary function is normal and healthy non-smokers were significantly different. The results between heavy smokers group and the non-smoker group were significantly different. The energy peak value ratio of inspiration and expiration phase in heavy smoker group, healthy non-smoker group were respectively 0.56,0.74.ConclusionThe study is preliminarily to explore the image properties of heavy smokers and healthy subjects. VRI can detect the abnormal image of the heavy smokers with normal pulmonary function,and detect image variation of heavy smokers 6 months since they stop smoking successfully.更多还原