【作者】 韩俊垒；

【导师】 汤兵祥；

【作者基本信息】 郑州大学 ， 内科学， 2011， 硕士

【摘要】 背景和目的：振动反应成像(Vibration response imaging, VRI)肺部呼吸成像诊断系统是一种全新的、利用振动反应成像技术进行肺部动态成像的设备,它通过采集肺部气流振动产生的信号,经数模转换和电子计算机处理,将肺内声音处理后转化为动态图像,识别干湿啰音,并能够计算两肺各个区域振动能量占全肺能量的百分比。VRI肺部呼吸成像诊断系统是一种非侵袭性、无辐射损害的检查方法,且操作简单,容易掌握,可由临床医生床边操作。目前这一检查方法引起了国内外的广泛关注,研究涉及呼吸系统相关疾病的研究以及心血管心衰等疾病的研究,目前多项研究均提示振动反应成像系统(Vibration response imaging system, VRIXP)在健康人群中具有稳定性、可重复性、在观察者之间可信度高；在啰音检测中灵敏度、特异度均较好；慢性阻塞性肺疾病(Chronic obstuctive pulmonary diseases, COPD)病人中VRI图像存在相对特异的表现等。本实验研究慢性阻塞性肺疾病病人与健康对照者之间的VRI差异,以期为临床诊断慢性阻塞性肺疾病提供新的依据,并研究慢性阻塞性肺疾病病人治疗前后VRI评分的变化、对比肺功能等指标,探讨VRI能否成为慢性阻塞性肺疾病的疗效观察提供新的方法。材料和方法：选取自2010年09月至2011年2月共计40位因慢性阻塞性肺疾病急性加重入住河南省胸科医院呼吸科病区的患者和40例健康志愿者,慢性阻塞性肺疾病(COPD)组符合《慢性阻塞性肺疾病诊治指南(2007)》中COPD的诊断标准：肺功能提示FEV1/FVC<70%(Forced expiratory volume in one second/forced vital capacity,第一秒用力呼气容积/用力肺活量的比例),年龄18-78岁,近期未使用支气管扩张剂或已洗脱。健康对照者纳入标准为：年龄18-65岁之间,肺功能80%<FEV 1 pred%<120%(Forced vital capacity用力肺活量占预计值的百分比),80%≤FVC≤120%(forced vital capacity,用力肺活量),FEV1/FVC>75%(Forced expiratory volume in one second/forced vital capacity第一秒用力呼气容积/用力肺活量的比值).不吸烟,近期未使用支气管扩张药物,一般情况良好,无心肺基础疾病。排除标准均为：多毛症,胸廓,脊柱畸形(如：鸡胸、脊柱侧弯),安装有心脏起搏器等影响肺部声音采集可能者。其中COPD病人中男性占31例,女性9例,平均年龄为54.24+11.17岁,健康人群中男性22例,女性18例,平均年龄41.46±938岁。所有COPD病人经抗炎、平喘治疗10-18天后,胸闷、气喘症状缓解,一般情况好转,再次行血常规、动脉血气分析、肺功能、VRI等检查。观察：健康人VRI图像特点及COPD病人VRI图像特点；听诊啰音与VRI啰音监测的关系；COPD病人治疗前后VRI评分的差别与肺功能变化。描述COPD及健康志愿者听诊干湿啰音与VRI图像监测的关系；以及二者MEF(最大能量图,Max energy frame)、图像发展动态、图像跳跃感、EVP曲线(声学信号,Envelope of Acoustic Signal)等的差异；以及COPD病人治疗前后MEF、振动曲线、跳跃感等的差异。用SPSS13.0统计分析软件包进行数据处理,计量资料以x±s表示,非正态分布资料用算术均数表示。组间比较用t检验,率的比较用χ2检验,P<0.05为有统计学意义。结果：1.健康志愿者的震动能量曲线光滑连续,12秒内包含3-4个周期,最高振动能量值在1.5-3.5之间,每个周期由吸气相和呼气相组成,震动能量图两肺同时出现,动态图像同步发展。图像没有跳跃,少见干湿啰音。最大能量图基本没有缺损,边缘光滑完整。志愿者性别、年龄对VRI图像总评价(啰音数量、曲线异常、跳跃感、MEF形态异常)结果无影响(P>0.05)。2.健康志愿者听诊均未发现啰音,VRI监测发现3例存在啰音,听诊啰音符合率为92.5%。COPD患者中33例听诊存在啰音,VRI检测中发现29例存在啰音,其符合率为87.9%。在健康志愿者和COPD患者中,VRI啰音监测与听诊的总体符合率为90.4%。3.COPD患者VRI图像观察：啰音出现、曲线呼气相低平、图像发生发展不同步性、EVP (Envelope of Acoustic Signal)振幅不同、EVP出现不同步性、MEF图像面积左右不相等、MEF缺失比例方面COPD组明显高于健康组,两组之间有统计学意义。4.COPD患者治疗前后VRI图像总评价(啰音数量、曲线异常、跳跃感、MEF形态异常)的比较存在显著差异(P<0.05),而曲线异常的单独评价差异不显著(P>0.05)。VRI的改善值与FEV1改善率存在线性相关关系r=-0.617(P<0.05)。,回归方程Y=0.067-0.156X.(Y:FEV1变化值,X:VRI图像评分变化)。结论：1.健康人群的在不同年龄、性别之间的VRI检查无明显差异,具有良好的稳定性,VRI检查可以作为一项客观指标来评价肺功能。2.在COPD患者和健康志愿者VRI啰音监测和听诊具有一致性,符合临床使用的要求。3. COPD患者VRI结果与正常人存在显著差异,可协助COPD的诊断。4. COPD患者治疗前后VRI图像总评价存在显著差异,VRI的改善值与FEV1改善率存在良好的相关性,因此可考虑作为一项判断疗效的指标。更多还原

【Abstract】 Background and purpose:Vibration Response Imaging (VRI) of pulmonary respiratory imaging diagnostic system is a new device, which uses VRI technology for dynamic imaging of lung. It collects signals generated by pulmonary flow vibration, processes them through digital-analog conversion and computer, and then the pulmonary sound is able to be converted to dynamic images, which can identify wet and dry rales and calculate each particular pulmonary region’s vibrational energy percentage of both lungs. The system is a non-invasive examination method without radiation damage. The operation is simple and easy to grasp, and clinicians can operate bedsides.Currently, the examination method has attracted wide attention at home and abroad, and the studies involve related respiratory system diseases, cardiovascular diseases and heart failure and so on. The present study indicates that Vibration Response Imaging System(VRIXP) is stable,repeatable for healthy people and highly reliable for examinees;its sensitivity and specificity are good in rales detection; there is significant difference in chronic obstructive pulmonary diseases (COPD) VRI image and so on.This experiment continues to study the VRI differences between patients suffered chronic obstructive pulmonary disease and healthy samples in order to provide new basis for clinically diagnosing such diseases, what’s more, it studies VRI score changes before and after related treatment and compares lung function and blood-routine indicators in order to provide new basis for treatment efficacy observation and follow-up in the future.Materials and methods:Select 40 patients suffered acute chronic obstructive pulmonary disease and 40 healthy volunteers.The patients were hospitalized in respiratory ward of Henan Chest Hospital from September 2010 to February 2011.COPD group meets the diagnostic criteria in COPD Diagnosis and Treatment Guidelines (2007):lung function FEV1/FVC<70%(Forced expiratory volume in one second/forced vital capacity), age betweenl8-78 years old, recently either used bronchodilators or were washed off. Healthy samples’ selection criteria:age between 18-65 years old, lung function 80%≤FEVlpred%≤120% (Forced vital capacity),80%≤FVC≤120%(forced vital capacity), FEV1/FVC> 75% (Forced expiratory volume in one second/forced vital capacity),do not smoke, recently did not use bronchodilators, good condition, without basic cardiopulmonary diseases. Exclusion criteria of both:hirsutism, thoracic, spinal deformity (eg:chicken breast, scoliosis), install cardiac pacemakers which may affect collecting pulmonary sounds and so on. Among the COPD patients, 31 patients were male and 9 patients were female;average age was 54.24±11.17 years old. Among the healthy people,22 patients were male and 18 patients were female;average age was 41.46±9.38 years old. After 10-18 days’anti-inflammatory and asthma treatment,for all COPD patients, their symptoms of chest tightness and asthma are eased; general condition was improved. Another examination of lung function and VRI were performed. Observe:VRI image characteristics of both healthy people and COPD patients; the relationship between rales auscultation and VRI monitoring of rales; VRI scores and lung function changes before and after treatment for COPD patients. describe the relationship between dry and wet rales auscultation and VRI monitoring of rales involving both COPD patients and healthy volunteers, the differences of MEF, vibration curve, jumping sense, EVP and so on about both COPD patients and healthy volunteers; the differences of MEF, vibration curve, jumping sense, EVP and so on between before and after treatment for COPD patients.The date was processed by SPSS 13.0 statistic software package and analyzed statistical.Measurement data was expressed in x±s, and non-normally distributed data was expressed in the arithmetic mean. Groups comparison was tested by t; rates comparison was tested byχ2;P<0.05 was considered statistically significant.Results:1. For healthy volunteers, vibration energy curve is smooth and continuous; there are 3-4 cycles in 12 seconds; the range of the maximum vibrational energy value is from 1.5 to 3.5; each cycle is composed by inspiratory and expiratory phase; both lungs appear at the same time in the vibration energy diagram; dynamic images change simultaneously. The image does not jump and dry and wet rales are rare. Few defects appeared in the maximum energy diagram and the edge was smooth and complete. Volunteers’ gender and age had no effect on general assessment about VRI image (the number of rales, abnormal curve, jumping sense, abnormal morphology of MEF) (P> 0.05).2. For healthy volunteers, rales were found in all of them by auscultationin, rales were found only in 3 cases by VRI monitoring and auscultation meeting rate was 92.5%. For COPD patients, rales were found in 33 cases by auscultationin, rales were found only in 29 cases by VRI monitoring and the meeting rate was 87.9%. For both healthy volunteers and COPD patients, the overall meeting rate by both VRI monitoring and auscultation was 90.4%.3. VRI observation of COPD patients:rales appeared; curve expiratory phase was low and flat; images did not change simultaneously; the amplitude of EVP (Envelope of Acoustic Signal) was different; EVP was not simultaneous; the size of MEF’s left side did not equal the right side; in terms of MEF proportion missing, COPD group was significantly higher than healthy group. (P<0.05 between the two groups)4.There were significant differences between the general assessment about VRI image (the number of rales, abnormal curve, jumping sense, abnormal morphology of MEF)before and after treatment for COPD patients (P>0.05), however, the separate evaluation of abnormal curve was not significantly different (P>0.05). There were linear correlation between VRI improved value and FEV1 improved rate r =-0.617(P<0.05). The regression equation Y=0.067-0.156X (Y:FEV1 improved rate, X:VRI Image improved value).Conclusion:1. For healthy people, there are no significant differences between different age and gender after VRI examination, which has good stability. It indicates that VRI examination could be considered as an objective index to evaluate lung function.2. For both COPD patients and healthy volunteers, VRI monitoring of rales is Consistent with auscultation, which meets the requirements of clinical treatment.3. In terms of VRI results, there are significant differences between COPD patients and healthy people and the results can help diagnose COPD.4. There are significant differences between the general assessment about VRI image before and after treatment for COPD patients, there is correlation between VRI improved value and FEV1 improved rate. So It can be considered as an indicator to evaluate treatment besides.更多还原