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目的评价MSCT的肺容积指标在诊断慢性阻塞性肺疾病(COPD)方面的应用价值。方法对40例临床确诊为COPD疾病的患者及对照组26例健康志愿者,进行胸部MSCT扫描,测量和计算各肺容积相关指标,并与临床肺功能指标进行相关性分析。用ROC曲线法评价肺容积各项指标在预测诊断和筛检COPD病人的准确性和灵敏性。结果正常组与COPD组在最大吸气末容积(Vin)、最大呼气末容积(Vex)、容积比(Vex/Vin)及肺容积变化比率指标存在明显差异(P<0.05)。Vex与第1s用力肺活量实测值与预测值百分比(FEV1)和第1s用力肺活量与用力肺活量的比值(FEV1/FVC)有较好的相关性,相关系数分别为r=-0.503,-0.673。Vin、Vex、容积比(Vex/Vin)及肺容积变化比率最恰当的预测COPD的临界点分别为5277、3329、0.69、0.30,其约登指数分别为0.558、0.73、0.565、0.565。其中以Vex的临界值预测诊断准确性最高,应用该临界值诊断灵敏度为73.9%,特异性为93.7%,约登指数为0.73。结论MSCT肺容积指标在预测诊断和筛检COPD病人中具有较高的临床应用价值。
Objective To evaluate the value of lung volume index of MSCT in the diagnosis of chronic obstructive pulmonary disease (COPD). Methods Forty-six healthy volunteers with COPD disease and control group were enrolled in this study. Their thoracic MSCT was performed to measure and calculate the relevant indexes of each lung volume, and to analyze the correlation with clinical pulmonary function parameters. ROC curve evaluation of the various indicators of lung volume in the diagnosis and screening of patients with COPD accuracy and sensitivity. Results There were significant differences between the normal group and the COPD group in the maximum end-inspiratory volume (Vin), maximum end-expiratory volume (Vex), volume ratio (Vex / Vin) and lung volume change ratio (P <0.05). There was a good correlation between Vex and FEV1 and FEV1 / FVC at 1s, r = -0.503 and -0.673, respectively. Vein / Vex, Vex / Vin and lung volume changes were the best predictors of COPD. The critical points of COPD were 5277,3329,0.69,0.30, and the Youden indices were 0.558,0.73,0.565,0.565 respectively. Among them, the diagnostic accuracy of Vex was the highest. The diagnostic sensitivity of this threshold was 73.9%, the specificity was 93.7%, and the Youden index was 0.73. Conclusion MSCT lung volume index has a high clinical value in predicting the diagnosis and screening of COPD patients.