中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2009年
2期
124-127
,共4页
肺疾病,问质件%体层摄影术,X线计算机%糖皮质激素类
肺疾病,問質件%體層攝影術,X線計算機%糖皮質激素類
폐질병,문질건%체층섭영술,X선계산궤%당피질격소류
Lung diseases,interstitial%Tomography,X-ray computed%Glucocorticoids
目的 评价高分辨率CT(HRCT)半定量分值对于特发性间质性肺炎(IIP)患者糖皮质激素(简称激素)近期治疗反应和预后的意义.方法 回顾性分析2001年1月至2007年5月北京大学第三医院收治的83例IIP患者.HRCT选择气管分叉处、左心房顶、右膈肌顶3个层面作为研究对象.计算网格影和蜂窝病变在3个层面上所占百分比的算术均值(HRCT分值),分别以HRCT分值10%、20%、30%、40%和50%为临界点,判断激素治疗效果的敏感度、特异度和准确度.独立样本采用.t检验或秩和榆验,定性资料采用x2检验.结果 以HRCT分值20%为临界点的准确度最高(70.6%).将83例中使用激素治疗的51例分为HRCT分值≥20%组25例,<20%组26例,其住院期问病死率分别为40.0%和3.8%(X2=9.848,P<0.01),激素近期治疗有效率分别为8.0%和50.0%(x2=10.829,P<0.01),平均住院时间的中位数(四分位间距)分别为3.0(1.0～6.5)个月和1.2(0.7～2.0)个月(z=-2.758,P<0.01),病程的中位数(四分位间距)分别为24.0(4.0～48.0)个月和2.0(1.0～12.0)个月(z=-2.900,P<0.01).共15例明确病珲分型,其中HRCT分值≥20%组4例,均为普通型问质性肺炎(UIP);<20%组11例,分别为急件问质性肺炎1例,UIP 1例,非特异性问质性肺炎9例.结论 HRCT分值有助于判断IIP患者激素治疗的近期反应.HRCT分值20%足较为合适的临界值,并与病理诊断具有较好的一致性.
目的 評價高分辨率CT(HRCT)半定量分值對于特髮性間質性肺炎(IIP)患者糖皮質激素(簡稱激素)近期治療反應和預後的意義.方法 迴顧性分析2001年1月至2007年5月北京大學第三醫院收治的83例IIP患者.HRCT選擇氣管分扠處、左心房頂、右膈肌頂3箇層麵作為研究對象.計算網格影和蜂窩病變在3箇層麵上所佔百分比的算術均值(HRCT分值),分彆以HRCT分值10%、20%、30%、40%和50%為臨界點,判斷激素治療效果的敏感度、特異度和準確度.獨立樣本採用.t檢驗或秩和榆驗,定性資料採用x2檢驗.結果 以HRCT分值20%為臨界點的準確度最高(70.6%).將83例中使用激素治療的51例分為HRCT分值≥20%組25例,<20%組26例,其住院期問病死率分彆為40.0%和3.8%(X2=9.848,P<0.01),激素近期治療有效率分彆為8.0%和50.0%(x2=10.829,P<0.01),平均住院時間的中位數(四分位間距)分彆為3.0(1.0～6.5)箇月和1.2(0.7～2.0)箇月(z=-2.758,P<0.01),病程的中位數(四分位間距)分彆為24.0(4.0～48.0)箇月和2.0(1.0～12.0)箇月(z=-2.900,P<0.01).共15例明確病琿分型,其中HRCT分值≥20%組4例,均為普通型問質性肺炎(UIP);<20%組11例,分彆為急件問質性肺炎1例,UIP 1例,非特異性問質性肺炎9例.結論 HRCT分值有助于判斷IIP患者激素治療的近期反應.HRCT分值20%足較為閤適的臨界值,併與病理診斷具有較好的一緻性.
목적 평개고분변솔CT(HRCT)반정량분치대우특발성간질성폐염(IIP)환자당피질격소(간칭격소)근기치료반응화예후적의의.방법 회고성분석2001년1월지2007년5월북경대학제삼의원수치적83례IIP환자.HRCT선택기관분차처、좌심방정、우격기정3개층면작위연구대상.계산망격영화봉와병변재3개층면상소점백분비적산술균치(HRCT분치),분별이HRCT분치10%、20%、30%、40%화50%위림계점,판단격소치료효과적민감도、특이도화준학도.독립양본채용.t검험혹질화유험,정성자료채용x2검험.결과 이HRCT분치20%위림계점적준학도최고(70.6%).장83례중사용격소치료적51례분위HRCT분치≥20%조25례,<20%조26례,기주원기문병사솔분별위40.0%화3.8%(X2=9.848,P<0.01),격소근기치료유효솔분별위8.0%화50.0%(x2=10.829,P<0.01),평균주원시간적중위수(사분위간거)분별위3.0(1.0～6.5)개월화1.2(0.7～2.0)개월(z=-2.758,P<0.01),병정적중위수(사분위간거)분별위24.0(4.0～48.0)개월화2.0(1.0～12.0)개월(z=-2.900,P<0.01).공15례명학병혼분형,기중HRCT분치≥20%조4례,균위보통형문질성폐염(UIP);<20%조11례,분별위급건문질성폐염1례,UIP 1례,비특이성문질성폐염9례.결론 HRCT분치유조우판단IIP환자격소치료적근기반응.HRCT분치20%족교위합괄적림계치,병여병리진단구유교호적일치성.
Objective To investigate HRCT semi-quantitative score in the response to corticosteroid treatment and prognosis in idiopathic interstitial pneumonia(IIP) patients.Methods Data from 83 IIP patients admitted in Peking University Third Hospital from January,2001 to Mav,2007 were retrospectively studied.Three sections of HRCT scans were analyzed,including the level of the tracheal canna,left atrium,and right diaphragmatic dome.The mean of percentage of reticular pattern and honeycombing on the 3 HRCT sections was calculated(HRCT score).To predict the sensitivity,specificity,and accuracy of the response to corticosteroid treatment when HRCT score was 10%,20%,30%,40%,50% as cutoff value.Software SPSS 11.0 was used for statistical analysis,the t test or Mann-Whitney u tests for quantitative variables and the chi-square test for qualitative variables.Results The most accurate(70.6%)cutoff value was HRCT score of 20%.In 83 IIP patients 51 cases were treated with corticosteroid.These patients were divided into 2 groups by the HRCT score:HRCT score≥120% group (n=25) and HRCT score<20% group(n=26).The mortality in hospital was 40.0% in HRCT score ≥20% group and 3.8% in HRCT score<20% group,x2=9.848,P<0.01.The percentage of effective treatment with corticosteroid was 8.0%in HRCT score ≥20% group and 50.0% in HRCT score<20%group,x2=10.829,P<0.01.The duration of hospitalization was 3.0(1.0-6.5) and 1.2(0.7-2.0) months in HRCT score ≥20% group and <20% group,z=-2.758,P<0.01.The course of IIP before using corticosteroid was 24.0(4.0-48.0)and 2.0(1.0-12.0)months in HRCT score ≥20% group and <20% group,z=-2.900,P<0.01.Pathologic pattern was identified in 15 cases in the 2 groups:4 UIP cases in group HRCT score≥20%;1 AIP cage,1 UIP case and 9 NSIP cases in group HRCT score <20%.Conclusions HRCT score helps to predict the recent response to corticosteroids.An HRCT score of 20% was an appropriate cutoff value and showed consistency with pathologic diagnosis.
