| Objective:1. To evaluate emphysematous and airway lesions of COPD by HRCT, and analyze correlation of the lesions and PFT.2. To discuss characteristics of emphysematous and non-emphysematous COPD.Research method:1. This is a clinical prospective case and control study. We designed three different groups: cases of COPD, cases of DSA merely, cases of normal PFT, and formulate the standards of enrollment and elimination. The diagnosis of COPD refers to the diagnostic and treatment guide in China (Recension of 2007). We collected HRCT data of the cases who measure up to standards, rebuilt CT image and measured indexes of emphysema (PI-950 and emphysematous visual scoring) and airway (Ai,Ao,Ai%,WA and WA%), and recorded PFT and clinical data, and made statistic analysis at last.2. We chose the patients of COPD in stable stage, and formulated the standards of enrollment and elimination. We collected HRCT, PFT and general data of the cases who measure up to standards. Emphysema visual scoring (EVS) is a scoring method which represents the severity of emphysema by HRCT (For details, please see the second part).We devided the cases into two phenotypes depending on EVS:emphysematous phenotype (EVS>0 point) and non-emphysematous phenotype (EVS=0 point).We compared the airway lesions and PFT data of the two phenotypes.Results:1. The changes of HRCT and PFT data in COPD and the correlation between HRCT and PFT(1) General information:From March 2008 to March 2010,54 COPD cases,33 SAD cases and 30 normal PFT cases were enrolled in this study from the population who were examined physically in Senior Officials inpatient Ward of our hospital. All cases are male. Age of COPD group is 73.43±10.7 (range from 55 to 94), DSA group 70.45±8.80 (range from 53 to 91), and normal PFT group 69.03±10.77 (range from 52 to 89).There are 40 smokers in COPD group (74.07%), smoking index is 28.92±18.28 pack-years; 16 smokers in DSA group (48.48%), smoking index is 18.81±8.94 pack-years; 12 smokers in normal PFT group (40.00%), smoking index is 15.50±9.28 pack-years. In COPD group,21 cases are PFT 1 grade (38.89%),27 cases are PFT 2grade (50.00%),6 cases are PFT 3 grade (11.11%).(2) Emphysematous data:Mean rank of PI-950 in COPD group is 74.23, DSA is 47.58, and normal PFT is 44.15. There is significant difference among three groups'PI-950 (P=0.000). Comparison between two groups, there are differences between COPD group and two other groups, no differences between DSA group and normal PFT group (P=0.495).(3) Airway data:Ai of COPD group is 5.67±2.48mm2, DSA group is 7.17±3.35 mm2, normal PFT is 7.03±2.55mm2.There is statistical difference among three groups'Ai (F=3.924,P=0.022). Ai% of the three groups is 24.47±6.56%,28.73±7.73% and 27.91±5.91% successively, and has significant difference (F=4.886, P=0.009). The difference of Ai and Ai% merely exists between COPD group and other two groups. WA of COPD group is 17.14±4.94mm2, DSA group is 16.95±3.78 mm2, normal PFT is 17.92±4.32mm2.But there is no statistical difference among three groups' WA (F=0.427,P=0.653). WA% of the three groups is 75.53±6.56%,71.27±7.73% and 72.09±5.91% successively, and has significant difference (F=4.886, P=0.009), which merely exists between COPD group and other two groups.(4) PFT data:FEV1%pre of COPD group is 74.02±16.85, DSA group is 92.70±13.76%, normal PFT is 103.63±11.17%.There is significant difference among three groups' FEV1%pre (F=42.593, P=0.000). FEV1/FVC of the three groups is 57.67±8.42%,72.42±3.19% and 78.37±4.21% successively, and has significant difference (F=118.502, P=0.000). FEF25%-75% %pre of the three groups is 31.08±12.88%,61.55±12.31% and 93.17±18.16% successively, and has significant difference (F=184.874, P=0.000).The difference of FEV1%pre,FEV1/FVC and FEF25%-75%%pre is parawise among the three groups. PEF%pre of the three groups is 84.22±19.31%,06.33±17.86% and 106.70±18.93% successively, and has significant difference (F=20.397, P=0.000). RV/TLC of the three groups is 47.31±10.26%,38.21±6.33% and 38.03±7.33% successively, and has significant difference (F=16.627, P=0.000).DLCO%pre of the three groups is 96.33±18.29%,106.55±13.80% and 108.03±16.38% successively, and has significant difference (F=6.316, P=0.003). The difference of PEF%pre,RV/TLC and DLco%pre merely exists between COPD group and other two groups.(5) The correlation of emphysema and PFT:PI-950 is negatively correlated with FEV1%p (r=-0.32,P=0.019) and FEV1/FVC (r=-0.69, P=0.000). There is no correlation between PI-950 and PEF%p (r=-0.26, P=0.057). PI-950 is negatively correlated with FEF25%-75%%p (r=-0.60, P=0.000), and positively correlated with RV/TLC (r=0.28, P= 0.040). There is no correlation between PI-950 and DLCO%p (r=-0.23, P= 0.100)(6) The correlation of emphysema and PFT:Ai is only negatively correlated with RV/TLC (r=-0.31,P=0.023). Ai%is negatively correlated with RV/TLC (r=-0.49, P=0.000), and positively correlated with PEF%p (r=0.40, P=0.002). There is correlation between PI-950 and DLCO%p(r=-0.23, P= 0.100).WA is negatively correlated with FEV1/FVC(r=-0.32,P=0.019). WA%is negatively correlated with PEF%p(r=-0.40, P=0.002), and positively correlated with RV/TLC (r=0.49, P=0.000)2. The comparision of HRCT and PFT data between emphysematous and non-emphysematous COPD(1) General information:54 cases of COPD group had been devided into two phenotypes: emphysematous phenotype (EVS>0 point) and non-emphysematous phenotype (EVS=0 point). Emphysematous phenotype has 40 cases (74.07%), and EVS of this type ranges from 0.2 point to 10.0 points, among which 38 cases are mild,2 cases are moderate, non-emphysematous phenotype has 14 cases (25.93%).(2) Airway data:Ai of emphysematous phenotype and non-emphysematous phenotype is 6.03±2.66mm2,4.64±1.53mm2 respectively, and has statistical difference (t=-2.362, P=0.023). Ai% of the two phenotypes is 24.51±7.16%,24.37±4.65% respectively, and has no statistical difference (t=-0.064, P=0.949). WA of emphysematous phenotype and non-emphysematous phenotype is 18.18±5.05mm2,14.18±3.18mm2 respectively, and has significant difference (t=-2.766, P=0.008). WA% of the two phenotypes is 75.49±7.16%,75.63±4.65% respectively, and has no statistical difference (t=0.064, P=0.949). Ao of emphysematous phenotype and non-emphysematous phenotype is 24.21±6.76mm2,18.82±4.37mm2 respectively, and has significant difference (t=-2.773, P=0.008).(3) PFT data:FEV1/FVC of emphysematous phenotype and non-emphysematous phenotype is 56.15±8.57%,62.00±6.40% respectively, and has statistical difference (t=2.330, P=0.024). FEF25%-75%%p of the two phenotypes is 28.62±11.63%,37.93±14.11% respectively, and has statistical difference (t=2.428, P=0.019). FEV1 (t=2.538, P=0.014),FEF25%-75%(t=3.020, P=0.004), PEF (t=2.866, P=0.006),PEF%p (t=2.287, P=0.026) and DLCO (t=3.475, P=0.001) of the two phenotypes has statistical difference, and these data of emphysematous phenotype are less than of non-emphysematous phenotype.Conclusion:1. The patients of COPD have enlarged PI-950, decreased luminal area of airways, and relatively incrassated airway wall.2. PI-950 of COPD is better correlated with pulmonary ventilatory data (FEV1%p,FEV1/FVC) and the functional data of small airways, while airway data (Ai%,WA%) is better correlated with PEF%p and RV/TLC.3. HRCT combined with PFT can better evaluate COPD.4. Non-emphysematous phenotype of COPD has more evident airway lesions, while pulmonary ventilation, diffusion and small airway function of emphysematous phenotype slip more seriously.5. HRCT can contribute to the classification of COPD. |
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