| ObjectiveIdiopathic pulmonary fibrosis(IPF)is a chronic,progressive thin-walled lesion in the lung parenchyma with the unknown etiology and the prognosis appears to be very poor,usually where the patient shows death within 2.5 to 5 years after diagnosis.At present,the method of quantitative CT(QCT)detection is mainly applied to the determination of bone mineral content in the unit volume,and the correlation between quantitative CT and pulmonary function test is still lacking in a large number of systematic studies.This is not only because there is no definite quantitative standard for quantitative CT for organ testing but the lung function index is more and it is affected by the patient’s physiology and pathology.In order to explore the determination of quantitative CT and pulmonary function in patients with IPF,especially forced vital capacity and the correlation of carbon monoxide diffuse lung function,by searching through all the field of literature,this paper conducted a meta-analysis and according to the results of the analysis to explore the accuracy of quantitative method.MethodsBased on literatures published in CBM,CNKI,VIP,PubMed,EMBASE,Cochrane and universal database,this paper searched literatures of quantitative CT and pulmonary functional correlation in patients with IPF.After literature searching,the undesirable literatures were excluded.The inclusion literature was screened and the literature quality was evaluated.After the inclusion of literatures,the literature data was extracted.Then the subgroup was divided into subgroups according to the CT quantitative method and the PFT index.Whereas,CT quantitative methods are divided into two types:image based quantitative method and quantitative method based on CT index.According to the characteristics of CT images the former included four abnormal features:ground-glass opacities,reticular opacity,honeycombing structure and emphysema.The first three of these can be considered as an integrated study of interstitial lung disease.The latter quantitative methods in line with CT index,which was based on CT histogram,including three indicators:MLA,skewness and kurtosis.This paper chooses two indexes of pulmonary function,which was closely related to the IPF patients.One was the forced vital capacity,which reflected pulmonary ventilation function;the other was diffusion capacity for carbon monoxide of the lung,which was reflected pulmonary diffusion function.This paper respectively to investigate the correlation between every CT quantitative indicators and FVC and/or DLco.Due to the original literature research only reported the correlation coefficient r for the correlation between both sides,and different researchers might perform Spearman or Pearson correlation statistics methods.In order to make the results more reliable,this paper will switch the Pearson correlation coefficient as the Spearman correlation coefficient,then the correlation coefficients proceed Fisher’s Z transformation and correlation meta-analysis did with Fisher’s Z value.After getting the total effect value of the Fisher’s Z value,a retro-Fisher’s Z transformation was done to afford correlation coefficient r.The final correlation analysis of the both sides for every subgroup was analyzed by correlation coefficient r and obtained meta-analysis conclusion.In addition,we also conducted sensitivity and heterogeneity analysis of the subgroups in this research.All meta-analyses were conducted with the software RevMan 5.2 recommended by Cochrane for data analysis.ResultesThrough literature retrieval and literature screening,this paper has included 10 studies from seven databases,including 2 Chinese and 8 English literatures,with a total of 1,167 cases.The studies were completed between 2002 and 2017.Only two of the articles were completed by 2013 and the remaining studies were done from 2013-2017.The included literatures were relatively new.Among the included literatures,research about the correlation between ground-glass opacity and forced vital capacity was 4 with a total of 277 cases,the r总 and 95%confidence interval was-0.23[-0.35,-0.11].The result was statistically significant and weak negative correlation existed between the two indexes;research about the correlation between ground-glass opacity and diffusion capacity for carbon monoxide of the lung was 5 with a total of 310 cases,the r 总 and 95%confidence interval was-0.30[-0.44,-0.16].The result was statistically significant and weak negative correlation existed between the two indexes;research about the correlation between reticular opacity and forced vital capacity was 4 with a total of 277 cases,the r总 and 95%confidence interval was-0.43[-0.55,-0.31].The result was statistically significant and moderate strength negative correlation existed between the two indexes;research about the correlation between reticular opacity and diffusion capacity for carbon monoxide of the lung was 5 with a total of 310 cases,the r 总 and 95%confidence interval was-0.37[-0.48,-0.26].The result was statistically significant and weak negative correlation existed between the two indexes;research about the correlation between honeycombing area and forced vital capacity was 5 with a total of 348 cases,the r总 and 95%confidence interval was-0.33[-0.45,-0.21].The result was statistically significant and moderate strength negative correlation existed between the two indexes;research about the correlation between honeycombing area and diffusion capacity for carbon monoxide of the lung was 6 with a total of 381 cases,the r总.and 95%confidence interval was-0.45[-0.56,-0.34].The result was statistically significant and moderate strength negative correlation existed between the two indexes;research about the correlation between emphysema and forced vital capacity was 4 with a total of 887 cases,the r总 and 95%confidence interval was 0.19[0.08,0.30].The result was statistically significant and extreme weak positive correlation existed between the two indexes;research about the correlation between emphysema and diffusion capacity for carbon monoxide of the lung was 5 with a total of 887 cases,the r总 and 95%confidence interval was-0.11[-0.09,0.11].The result was statistically significant and nearly no correlation existed between the two indexes;research about the correlation between interstitial lung disease and forced vital capacity was 2 with a total of 631 cases,the r总 and 95%confidence interval was-0.44[-0.52,-0.36].The result was statistically significant and moderate strength negative correlation existed between the two indexes;research about the correlation between interstitial lung disease and diffusion capacity for carbon monoxide of the lung was 2 with a total of 631 cases,the r总 and 95%confidence interval was-0.34[-0.41,-0.27].The result was statistically significant and weak negative correlation existed between the two indexes;research about the correlation between mean lung attenuation and forced vital capacity was 2 with a total of 190 cases,the r总 and 95%confidence interval was-0.52[-0.60,-0.44].The result was statistically significant and moderate strength negative correlation existed between the two indexes;research about the correlation between mean lung attenuation and diffusion capacity for carbon monoxide of the lung was 2 with a total of 190 cases,the r总 and 95%confidence interval was-0.52[-0.60,-0.44].The result was statistically significant and strength negative correlation existed between the two indexes;research about the correlation between skewness and forced vital capacity was 3 with a total of 201 cases,the r 总 and 95%confidence interval was 0.53[0.39,0.67].The result was statistically significant and moderate strength positive correlation existed between the two indexes;research about the correlation between skewness and diffusion capacity for carbon monoxide of the lung was 3 with a total of 201 cases,the r 总 and 95%confidence interval was 0.41[0.27,0.55].The result was statistically significant and moderate strength positive correlation existed between the two indexes;research about the correlation between kurtosis and forced vital capacity was 3 with a total of 201 cases,The result has no statistically significance,but the three included literatures all reflected positive correlation existed between the two indexes;research about the correlation between kurtosis and diffusion capacity for carbon monoxide of the lung was 3 with a total of 201 cases,the r总 and 95%confidence interval was 0.44[0.30,0.58].The result was statistically significant and moderate strength positive correlation existed between the two indexes.ConclusionIn patients with IPF,quantitative CT and PFT has certain relevance.Among several indicators based on CT images,except emphysema the rest GGO%,RO%and HA%showed a negative correlation with FVC and the total area of ILD was negatively correlated with FVC.In these anomalous structures,RO%has the most correlation with FVC,showing the negative correlation of moderate intensity.But ILD and FVC showed a moderate negative correlation.GGO%,RO%and HA%also showed a negative correlation with DLco,the total area of the three kinds of abnormal structure—ILD also showed negatively correlated with DLco.Among them,the HA%showed moderate strength correlation with DLco,and other indicators like DLco showed the weak correlation.Emphysema structure showed extremely weak correlation.In quantitative method based on CT index,in several indicators of histogram,MLA was negatively related to the FVC with moderate strength and negatively related to the DLco with strength.Skewness was positively related to the FVC with moderate strength and positively related to the DLco with moderate strength.Because statistical differences existed for the included literatures,the correlation between kurtosis and FVC cannot be concluded.But according to the three literatures with a total of 201 cases,kurtosis and FVC had positive correlation,but the correlation intensity showed bigger differences between literatures.Kurtosis and DLco had moderate positive correlation.In quantitative method based on CT index,due to the effect of other factors were great and its accuracy was lower than the quantitative method based on CT images.But in the quantitative method based on CT images,method of selecting several levels of CT images which estimated by radiologists was influenced by human factors.So,the quantitative could not accurately reflect abnormal structures of pulmonary in three-dimensional visual angle.Therefore,computer automatic quantitative method was recommended,and three-dimensional quantitative method was used for accurately quantitated all abnormal structure in pulmonary.After considering the various pulmonary abnormal structure in IPF patients,the boundary judgment of GGO,HA and RO was fuzzy.However,the CT images of patients with IPF will show these abnormal structures,which can be considered as a unified whole to predict the lung function of patients.Such correlations can be more reliable. |
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