【作者】 李俊；

【导师】 蔡柏蔷； 许文兵； 高金明；

【作者基本信息】 中国协和医科大学 ， 呼吸内科学， 2009， 博士

【摘要】 研究背景振动反应成像（VRI）是近年来出现的一种新型肺部成像技术,可以显示受试者呼吸过程中肺部的振动情况。目前国际上已广泛开展了关于VRI的临床研究。国内尚未见到对正常人及慢性阻塞性肺疾病（COPD）患者VRI特点的临床研究报道。目的对试验中VRI设备的临床使用进行评估。描述正常人及COPD患者VRI的检查特点,初步探讨VRI正常参考值的范围及其对COPD的诊断价值。VRI显示受试者呼吸振动的肺部定量数据（QLD）,探讨QLD在COPD和支气管哮喘等气流受限疾病中的诊断价值。方法招募66名健康志愿者进行临床检查、肺功能检查（PFT）和VRI检查。随机纳入63例门诊COPD患者,在支气管舒张试验前后分别进行临床检查、PFT和VRI检查。对试验中VRI设备的临床使用进行评估。VRI检查结果分为右肺QLD、啰音数和图像评分三部分,对两组结果分别进行描述、分析并比较。在回顾性的QLD研究部分,从上述试验中选择有三次重复QLD资料的受试者,包括64例健康志愿者、61例COPD患者。并回顾了我院一项相关研究中58例支气管哮喘患者的QLD资料。采用公式将QLD转换为异常度和波动度两项指标,然后在各组间进一步分析、比较。结果66名健康志愿者和63例COPD患者进行了576次VRI检查。传感器吸附率97.7%。患者均能配合,未发现不良反应。啰音检测与听诊的符合率91.5%。健康志愿者VRI图像有固有的特点,其右肺QLD 45.1%±5.9%,啰音均数0.1,图像平均分0.9。初步正常参考范围为:（1）|右肺QLD-45%|＜12%,（2）啰音数＜4,（3）图像评分＜4,超出其中任何一项都提示VRI异常。上述标准在该组受试者中诊断特异度为90.9%。COPD患者VRI图像有别于正常人,支气管舒张试验前后VRI结果无显著差异（P＞0.05）。支气管舒张试验后右肺QLD 51.0%±12.1%,哕音均数2.7,图像评分4.2±1.9,且图像评分与FEV₁%呈线性相关关系（r=0.31,P=0.01）。COPD患者与健康志愿者之间均存在显著差异（P＜0.01）。根据前述VRI正常参考值范围,该组COPD患者中诊断灵敏度为74.6%。健康志愿者中肺部右上、右中、右下、左上、左中、左下6个部位QLD均值分别为（8.4,14.5,22.0,11.1,18.5,25.5）,计算异常度均值10.0,波动度均值2.0。COPD患者支气管舒张试验前后QLD异常度、波动度无改善（P＞0.05）,舒张试验后异常度均值47.1,波动度均值10.9。支气管哮喘患者支气管舒张试验前异常度均值58.1,波动度均值12.2,舒张试验后异常度有改善（P＜0.01）。COPD和支气管哮喘患者的异常度、波动度均明显高于健康志愿者（P＜0.05）。初步设想以异常度＜20.0且波动度＜5.0为正常参考范围,健康志愿者中诊断特异度87.5%,COPD患者中诊断灵敏度82.0%,支气管哮喘患者中诊断灵敏度82.8%。结论VRI设备使用方便,性能稳定,与听诊检查的一致性好,未发现不良反应,符合临床使用的要求。正常人VRI结果存在显著特点。COPD患者VRI结果与正常人存在显著差异,且支气管舒张试验前后无明显改善,可协助COPD的诊断。支气管舒张试验后VRI图像评分对估计COPD患者气流受限程度有一定价值。通过公式将QLD转换为异常度和波动度两项指标后,可以较好的区分正常人和气流受限疾病患者,且有助于COPD和支气管哮喘的鉴别,有一定的临床诊断价值。更多还原

【Abstract】 Background Vibration response imaging（VRI）is a new lung sound imaging technology which shows the vibration in the lungs during respiratory period. Now clinical researches about VRI can been found all over the world.But no clinical report which study the VRI characters in healthy subjects and obstructive lung diseases patients can be found in China up to date.Objective First to value the clinical use of VRI device used in this research.Then our research was aimed to describe the characters of VRI in healthy subjects and chronic obstructive pulmonary disease（COPD） patients, and to explore the range of reference value in healthy people and its value in diagnosing COPD.VRI provides quantitative lung data（QLD）of vibration in respiratory period.The research also explored the value of QLD in diagnosing obstructive lung diseases such as COPD and asthma.Methods 66 healthy subjects received clinical examination,pulmonary function test（PFT） and VRI examination.63 COPD patients received clinical examination,PFT and VRI examination before and after inhalation of bronchodilator.The clinical use of VRI device was valued carfully.We defined VRI results as QLD of right lung,crack counts,and image grade. The results of two groups were described and analyzed seperately and then compared.In the retrospective research of QLD,the QLD of 64 healthy subjects, 61 COPD patients and 58 asthma patients in another research were reviewed. The QLD were transferred to abnormity and variation by a formulation,and the results were analyzed and compared between groups.Results 66 healthy subjects and 63 COPD patients received VRI examination for 576 times all together.The sensor successfully adsorbed in 97.7%subjects.Everyone can complete the examination and no adverse event（AE） was reported.Crack detectation was consistent with auscultation in 91.5%subjects.VRI results of healthy subjects have its characteres.The QLD of right lung was 45.1%±5.9%,mean crack counts 0.1,mean image grade 0.9.The range of reference value were as follows:（1） |QLD of right lung -45%|＜12%, （2） crack counts＜4,（3） image grade＜4,otherwise means abnormal.The specificity in this group was 90.9%.The VRI results of COPD patients were different from healthy people, and the results were similar before and after inhalation of bronchodilator （P＞0.05）.After inhalation of bronchodilator,the QLD of right lung was 51.0%±12.1%,mean crack counts 2.7,image grade 4.2±1.9.There was a linear relationship between VRI image grade and FEV₁%（r=0.31,P=0.01）.There was a statistical difference between COPD patients and healthy people（P＜0.01）. The sensitivity in this group was 74.6%.The mean QLD of six regions in healthy subjects were（8.4,14.5,22.0, 11.1,18.5,25.5）,mean abnormity 10.0,mean variation 2.0.Abnormity and variation in COPD patitients were similar before and after inhalation of bronchodilator（P＞0.05）.After inhalation of bronchodilator,mean abnormity was 47.1,mean variation 10.9.The mean abnormity of asthma patients were 58.1,mean variation 12.2.But after inhalation of bronchodilator,mean abnormity decreased（P＜0.01）.The abnormity and variation of patients were different from those of healthy subjects（P＜0.05）.If we define normal as abnormity＜20.0 and variation＜5.0,the specificity was 87.5%.The sensitivity of COPD was 82.0%and the sensitivity of asthma was 82.8%.Conclusion VRI device is convenient and reliable,consistent with auscultation and no AE was reported.So it is competent for clinical use. VRI results of healthy people have its characteres.There was a statistical difference between the VRI results of COPD patents and healthy subjects and the VRI results in COPD patents were stable after inhalation of bronchodilator,thus were helpful in diagnosing COPD.The VRI image grade after inhalation of bronchodilator was useful to assess the degree of obstruction.Using abnormity and variation which were transformed from QLD by the formulation,most COPD and asthma patients can be found from healthy people and can be identified from each other.更多还原