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目的探讨并评估定量CT在肺泡蛋白沉着症(PAP)支气管肺泡灌洗术中的应用价值。方法通过定量CT分析PAP患者最大吸气末肺气体总容积、肺总重量、肺平均CT值、肺平均密度值结果及像素指数直方图,对15例PAP患者共18次行肺泡灌洗术的CT资料进行定量分析,并结合肺功能检查(共14次)资料进行对比。结果 PAP经支气管肺泡灌洗术后,定量CT检查显示肺气体总容积有一定程度的增加(P=0.128),肺总重量从(1698±409)g减至(1307±381)g(P=0.001),平均CT值从(-761.7±36.1)HU减至(-895.7±26.3)HU(P=0.015),肺平均密度值从(0.5867±0.15)g/cm3减低至(0.4453±0.07)g/cm3(P=0.007)。像素指数直方图直观显示灌洗后像素指数范围较灌洗前减小。支气管灌洗术后有14次肺功能检查结果显示DLCO%从(50.15±19.18)%上升至(56.37±17.89)%(P=0.018)、DLCO/VA%从(70.01±19.18)%上升至(78.17±15.36)%(P=0.045);用力肺活量(FVC)、第一秒用力呼气量占预计值的百分比(FEV1%)、FEV1/FVC亦有不同程度的改善,但均无统计学意义(P>0.05)。结论定量CT可对PAP灌洗术的疗效评估提供比较客观、精确的依据,为临床评估PAP肺泡灌洗术的疗效提供新的评价方法。
Objective To investigate and evaluate the value of quantitative CT in bronchoalveolar lavage (PAP) of alveolar proteinosis (PAP). Methods Quantitative CT was used to analyze the maximum end-inspiratory volume, the total lung weight, the average lung CT value, the average lung density value and the pixel index histogram of PAP patients. CT data for quantitative analysis, combined with pulmonary function tests (a total of 14) data for comparison. Results Quantitative computed tomography (CT) examination showed that the total lung volume increased to some extent (P = 0.128) and the total lung weight decreased from (1698 ± 409) g to (1307 ± 381) g after PAP was administered by bronchoalveolar lavage (P = 0.001). The average CT value decreased from (-761.7 ± 36.1) HU to (-895.7 ± 26.3) HU (P = 0.015) and the mean pulmonary density decreased from (0.5867 ± 0.15) g / cm3 to (0.4453 ± 0.07) g /cm3(P=0.007). Pixel index histogram visually shows the range of pixel index after lavage decreased compared with before lavage. Fourteen lung function tests after bronchoalveolar lavage showed that DLCO% increased from (50.15 ± 19.18)% to (56.37 ± 17.89)% (P = 0.018) and DLCO / VA% increased from (70.01 ± 19.18)% to 78.17 ± 15.36)% (P = 0.045); FVC, FEV1%, and FEV1 / FVC also improved to some extent, but there was no statistical significance (P> 0.05). Conclusion Quantitative CT can provide an objective and accurate basis for evaluating the efficacy of PAP lavage and provide a new evaluation method for the clinical evaluation of PAP lavage.