【作者】 杨学东；

【导师】 路晓东；

【作者基本信息】 青岛大学 ， 影像医学与核医学， 2003， 硕士

【摘要】 目的：通过分析不同年龄组无症状非吸烟者吸气相、呼气相HRCT肺密度定量指标，探讨(1)健康成人随年龄的变化，呼吸气相HRCT定量指标的变化及其与肺功能的相关性；(2)年龄对呼气相CT空气潴留的影响以及空气潴留与肺功能的相关性。材料与方法：对经严格选择的63例无症状非吸烟者进行肺吸气末与呼气末HRCT扫描，其中32例进行肺功能测试。将所有受试者按年龄分为5组，评价随年龄增加肺吸气相呼气相定量指标的变化，及其与肺功能的相关性。对呼气相HRCT上空气潴留进行定量分析，并评价其与肺功能的相关性。结果：(1)各年龄组肺呼气相、吸气相CT平均肺密度值(单位HU)分别为：21-30岁组分别为-688.093±29.3875和-881.375±28.9531，31-40岁组-693.805±23.3521和-876.858±26.0755，41-50岁组-706.836±18.3758和-873.663±24.2965，51-60岁组-736.579±21.8974和-876.734±17.3546，61岁以上组-778.672±19.6581和-866.598±20.6975。(2)各年龄组的全肺平均吸呼气相CT肺密度差(单位为HU)分别为：21-30岁组为193.282±53.1184，31-40岁组183.053±64.1520，41-50岁组166.827±44.6268，51-60岁组140.155±39.9931，61岁以上组87.917±34.6236。随着年龄的增高，全肺密度差值呈降低趋势，而且这种降低在统计学上有显著意义(P＜0.01)。(3)FVC、FEV1、TLC与吸气相各个肺野及全肺的平均肺密度均有极显著的相关性(P＜0.01)，此三项指标与吸气相全肺平均密度的相关系数(r)分别为FVC=-0.682、FEV1=-0.694、TLC=-0.768；RV与吸气相中肺野平均肺密度极显著相关(P＜0.01)，与上、下肺野及全肺则为显著相关(P＜0.05)，与全肺的相关系数(r)为-0.565。(4)所有受试者总的空气潴留出现率为39.7％(25／63)，其中Ⅰ型22.2％(14／63)，Ⅱ型17.5％(11／63)，各组均未出现Ⅲ型空气潴留，也就是说没有一例受试者的空气潴留面积超过25％。其中以肺小叶型空气潴留为主的18例，以肺段型为主的9例，未出现肺叶型。(5)空气潴留组与无空气潴留组之间的FVC和FEV1／FVC平均值之间存在显著差异(P＜0.05)；FEV1／FVC更是与空气潴留的分级有明显的相关性(r=-0.529，P＜0.05)。结论：无症状非吸烟者随年龄变化，其吸呼气相HRCT肺密度定量指标，尤其是呼气相平均肺密度和肺密度中文摘要差，发生了相应的变化。无症状非吸烟者呼气相HRCT出现的空气储留约40%，年龄可能为其形成原因之一。无症状非吸烟者的肺功能在正常范围内时，吸呼气相HRCT仍可能反映某些指标的轻微变化:吸气相平均肺密度较好的与FVC、FEVI、TLC及RV相关;空气储留的面积分级则与FEVI/F VC呈明显的相关性。更多还原

【Abstract】 Objective: To study (1) the changes with aging of inspiratory and expiratory HRCT lung density parameters in asymptomatic nonsmokers, and the correlation with PFT(pulmonary function test) results;(2) the effect on expiratory HRCT air trapping resulted from aging and the correlation between air trapping and PFT results by quantitatively analyzing the inspiratory and expiratory HRCT mean lung density in different groups of asymptomatic nonsmokers. Materials and Methods: Lung HRCT scans were performed at end inspiratory and end expiratory in 63 subjects, and PFT were performed in 32 of them. All the subjects were divided into 5 groups according to the ages. Changes with aging of lung inspiratory and expiratory HRCT quantitative parameters and the correlation with PFT results were assessed. Air trappings in expiratory HRCT were quantitatively analyzed and the correlation between air trapping and PFT results were assessed. Results: (1) In each age group the mean lung density of inspiratory and expiratory lung HRCT respectively are(HU): 21-30years group respectively are-688.093±29.3875 and -881.375± 28.9531, 31-40 years group -693.805 ±23.3521 and -876.858 + 26.0755, 41-50 years group -706.836± 18.3758 and -873.663±24.2965, 51-60 years group -736.579 ± 21.8974 and -876.734 ± 17.3546 , more than 61 years group -778.672±19.6581 and -866.598 + 20.6975. (2) In each age group the overall mean lung density difference between inspiratory and expiratory HRCT respectively are (HU): 21-30 years group 193.282 ± 53.1184 , 31-40 years group 183.053 + 64.1520, 41-50 years group 166.827±44.6268, 51-60 years group 140.155 + 39.9931, more than 61 years group 87.917 ± 34.6236. With aging, the overall mean lung density difference between inspiratory and expiratory HRCT is on decrease, and the decrease is significantly different (P<0.01).(3)FVC, FEV1, TLC correlate significantly with mean lung density of each lung field and overall lung in inspiratory HRCT(P<0.01), and the correlation parameter (r) between these three results and the mean lung density of overall lung respectively are : FVC= -0.682, FEV1= -0.694, TLC= -0.768 : RV correlates extremely significantly with the middle lung field in inspiratory HRCT(P<0.01), significantly with the upper, lower lung fieldand overall lung(P<0.05), the correlation parameter with the overall lung is -0.565. (4) Air trapping occurred in 39.7% (25/63) subjects, including type I 22.2% (14/63), type II 17.5% (11/63), type III never occurred . In all cases with air trappings ,18 cases predominantly appear as lobular, 9 cases segmental, and none lobar air trapping. (5) The difference of FVC and FEV1/FVC between air trapping group and normal group is significant (P<0.05) : FEV1/FVC significantly correlate with the grade of air trapping especially (r = -0.529, P<0.05). Conclusion: Quantitative parameters of inspiratory and expiratory lung HRCT, especially mean lung density and the density difference changed subsequently with aging in asymptomatic nonsmokers. Air trapping occurred in about 40% asymptomatic nonsmokers and aging maybe one of its causes. Inspiratory and expiratory HRCT may reflect the subtle changes of PFT results within the normal ranges: FVC, FEV1, TLC and RV correlate significantly with inspiratory CT mean lung density. And there is significant correlation between FEV1/FVC and the area grade of air trapping.更多还原