Page 34 - 2022-27-中国全科医学

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【Abstract】 Background Low attenuation area ratio（LAA%） and pectoral major parameters are in elderly patients
with COPD related to pulmonary ventilation function，but there are few studies at home and abroad. Objective To analyze the
correlation of LAA% and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD，
and to explore the predictive value of LAA% and PMcsa in the severity of airflow restriction，in order to provide clinical basis for
the early detection and diagnosis of COPD. Methods A total of 270 elderly patients with stable COPD who underwent chest CT
and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June
2021 were selected and divided into GOLD Ⅰ group（FEV l %pred ≥ 80%，n=47），GOLD Ⅱ group （50% ≤ FEV l %pred<80%，
n=88）， GOLD Ⅲ group（30% ≤ FEV l %pred<50%，n=84）and GOLD Ⅳ group（FEV l %pred<30%，n=51） according
to GOLD classification with their general information and CT quantitative indexes recorded. Pearson correlation analysis and
multiple linear regression analysis were used to explore the relationship between LAA%，pectoralis major areas（PMcsa） and
lung function. The receiver operating characteristic curve（ROC curve） was used to evaluate the predictive value of LAA% and
PMcsa for FEV 1 %pred<50% and FEV 1 %pred<80%. Results BMI and PMD in GOLD Ⅰ group were higher than those in GOLD
Ⅲ group and GOLD Ⅳ group（P<0.05），and the BMI in GOLD Ⅱ group and GOLD Ⅲ group was higher than that in GOLD Ⅳ
group（P<0.05）. PMcsa，PMI，FEV 1 %pred，FEV 1 and FVC in GOLD Ⅰ group were higher than those in GOLD Ⅱ group，
GOLD Ⅲ group and GOLD Ⅳ group（P<0.05）. PMcsa，PMI，FEV 1 %pred，FEV 1 and FVC in GOLD Ⅱ group were higher
than those in GOLD Ⅲ group and GOLD Ⅳ group（P<0.05）. PMcsa，PMI ，FEV 1 %pred，FEV 1 and FVC in GOLD Ⅲ group
were higher than those in GOLD Ⅳ group（P<0.05）. Left lung LAA%，right lung LAA% and total lung LAA% in GOLD Ⅰ
group were lower than those in GOLD Ⅱ group，GOLD Ⅲ group and GOLD Ⅳ group（P<0.05）. Left lung LAA%，right lung
LAA% and total lung LAA% in GOLD Ⅱ group were lower than those in GOLD Ⅲ group and GOLD Ⅳ group（P<0.05）. Left
lung LAA%，right lung LAA% and total lung LAA% in GOLD Ⅲ group were lower than those in GOLD Ⅳ group（P<0.05）.
FEV 1 %pred，FEV 1 and FVC were positively correlated with PMcsa，PMI and PMD（P<0.05）. Both FEV 1 %pred and FEV 1
were negatively correlated with low attenuation area ratio（right LAA%，left LAA%，total LAA%）（P<0.05）. Multiple linear
regression analysis show that gender，total LAA% and PMcsa were independent influencing factors of FEV 1 %pred. The area under
ROC curve of right lung LAA%，left lung LAA%，total lung LAA% and PMcsa predicting FEV 1 %pred<50% in male patients
were 0.832，0.827，0.834，0.809，respectively. The area under ROC curve of right lung LAA%，left lung LAA%，total lung
LAA% and PMcsa predicting FEV 1 %pred<50% in female patientswere 0.844，0.801，0.845，0.839，respectively. The area
under ROC curve of right lung LAA%，Left lung LAA%，total lung LAA% and PMcsa predicting FEV 1 %pred<80% in male
patients were 0.830，0.815，0.831，0.844，respectively. The area under ROC curve of right lung LAA%，left lung LAA%，
total lung LAA% and PMcsa predicting FEV 1 %pred<80% in female patients were 0.805，0.817，0.807，0.846，respectively.
Conclusion The low attenuation area ratio and PMcsa can assess the severity of airflow restriction in elderly patients with
COPD，and can be used as an important tool for early screening and severity assessment of COPD.
【Key words】 Pulmonary disease，chronic obstructive；Aged；Respiratory function tests；Tomography，spiral
computed；Root cause analysis；Forecasting

慢性阻塞性肺疾病（以下简称慢阻肺）是一种以持 检查的 270 例稳定期慢阻肺患者为研究对象。纳入标准：
续的呼吸道症状和气流受限为特征的慢性小气道炎症性 （1）年龄≥ 60 岁，符合《2019 年慢性肺疾病诊断、
［1］
疾病，常表现为肺含气量增多和静息期耗能增加 ［1］ 。 治疗及预防全球策略解读》 中关于慢阻肺的诊断标准；
增龄作为老年慢阻肺患者独立易患因素，会使患者合并 （2）慢阻肺患者均处于病情稳定期，即临床症状稳定
肌肉萎缩、躯体功能下降，包括呼吸肌的生理性功能下 或轻微。排除标准：（1）4 周内出现慢阻肺急性加重者；
降，进一步影响其肺功能及生活质量 ［2］ 。CT 定量技术 （2）合并其他肺部疾病者，如：支气管扩张、肺间质
可反映老年慢阻肺患者肺低衰减区比例（LAA%）、胸 疾病、活动性肺结核、胸腔积液、肺占位、肺不张、肺
大肌参数及脂肪浸润情况，且以上指标与肺通气功能参 切除术、胸廓畸形等；（3）合并慢性肌肉骨骼疾病、
数具有良好的相关性 ［3-4］ 。本研究旨在通过 LAA% 及 重症肌无力等肌肉相关疾病者；（4）临床相关资料不
胸大肌参数来评估老年慢阻肺患者肺通气功能的受损程 完善者。本研究经扬州大学附属苏北人民医院伦理审批
度，为早期发现及诊断慢阻肺提供临床依据。 （2022ky116）。
1 对象与方法 1.2 方法
1.1 研究对象 选取 2019 年 12 月至 2021 年 6 月在扬 1.2.1 肺功能测量及分组 采用德国耶格公司生产的
州大学附属苏北人民医院就诊并完成胸部 CT 及肺功能 Master Screen Diffusion 肺功能仪行肺功能检查，记录的