CAJ | 학술논문

目的初步探讨通过肺部振动反应成像(VRI)系统记录的肺泡蛋白沉积症(PAP)患者肺部振动反应图像特点.方法选择2010年7月至2011年4月期间在北京协和医院呼吸科住院治疗的PAP患者12例行VRI检查,并收集患者临床资料.其中8例患者经全肺灌洗治疗,分别记录其全肺灌洗前后VRI图像特点.同时招募33名健康成年人作为健康对照组.统计学方法采用T检验、非参数检验及线性回归分析.结果 PAP患者VRI检查振动曲线评分0.50(0.00～2.75),动态图像发展评分1.50(1.00～2.00),最大振动能量图(MEF)评分3.00(1.25～3.75),右肺QLD值(46.67±8.52)％；健康对照组振动曲线评分0.00(0.00～1.00),动态图像发展评分0.00(0.00～1.00),MEF评分1.00(0.00～1.50),右肺QLD值(43.30±6.02)％,其中动态图像评分与MEF评分两组间差异有统计学意义(P＜0.05),而振动曲线评分及右肺QLD值两组间差异无统计学意义(P＞0.05).8例行全肺灌洗治疗患者,治疗前振动曲线评分1.50(0.00～3.50),动态图像发展评分1.50(1.00～2.00),MEF评分3.00(1.25～4.75),干湿啰音评分1.00(0.25～1.00),MEF面积(68.62±4.59)千像素,图像总评价6.00(4.25～9.00)；治疗后振动曲线评分0.50(0.00～1.75),动态图像发展评分1.00(1.00～1.00),MEF评分1.00(0.00～1.75),干湿啰音评分0.50(0.00～1.00),MEF面积(71.66±6.03)千像素,图像总评分3.00(2.00～3.75),其中MEF评分、图像总评分有显著改善(P＜0.05),MEF面积显著增大(P＜0.05),而振动曲线评分、动态图像发展评分以及于湿啰音评分无显著改善(P＞0.05).治疗前后氧合指数的改善与MEF评分、图像总评分以及MEF面积变化之间无线性相关关系.结论 PAP患者经肺泡灌洗后MEF面积显著增大,MEF形态显著改善,今后可望将VRI检查用于PAP患者的随访.
목적 초보탐토통과폐부진동반응성상(VRI)계통기록적폐포단백침적증(PAP)환자폐부진동반응도상특점.방법 선택2010년7월지2011년4월기간재북경협화의원호흡과주원치료적PAP환자12례행VRI검사,병수집환자림상자료.기중8례환자경전폐관세치료,분별기록기전폐관세전후VRI도상특점.동시초모33명건강성년인작위건강대조조.통계학방법채용T검험、비삼수검험급선성회귀분석.결과 PAP환자VRI검사진동곡선평분0.50(0.00～2.75),동태도상발전평분1.50(1.00～2.00),최대진동능량도(MEF)평분3.00(1.25～3.75),우폐QLD치(46.67±8.52)％；건강대조조진동곡선평분0.00(0.00～1.00),동태도상발전평분0.00(0.00～1.00),MEF평분1.00(0.00～1.50),우폐QLD치(43.30±6.02)％,기중동태도상평분여MEF평분량조간차이유통계학의의(P＜0.05),이진동곡선평분급우폐QLD치량조간차이무통계학의의(P＞0.05).8례행전폐관세치료환자,치료전진동곡선평분1.50(0.00～3.50),동태도상발전평분1.50(1.00～2.00),MEF평분3.00(1.25～4.75),간습라음평분1.00(0.25～1.00),MEF면적(68.62±4.59)천상소,도상총평개6.00(4.25～9.00)；치료후진동곡선평분0.50(0.00～1.75),동태도상발전평분1.00(1.00～1.00),MEF평분1.00(0.00～1.75),간습라음평분0.50(0.00～1.00),MEF면적(71.66±6.03)천상소,도상총평분3.00(2.00～3.75),기중MEF평분、도상총평분유현저개선(P＜0.05),MEF면적현저증대(P＜0.05),이진동곡선평분、동태도상발전평분이급우습라음평분무현저개선(P＞0.05).치료전후양합지수적개선여MEF평분、도상총평분이급MEF면적변화지간무선성상관관계.결론 PAP환자경폐포관세후MEF면적현저증대,MEF형태현저개선,금후가망장VRI검사용우PAP환자적수방.
Objective To describe the characters of vibration response imaging (VRI) in patients with pulmonary alveolar proteinosis (PAP).Methods 12 PAP patients and 33 healthy volunteers were enrolled.Both clinical examination and VRI test were performed.Parameters of VRI were measured,including vibration energy graph grades,dynamic image grades,areas of maximal energy frame (MEF),quantitative lung data (QLD) and rales.Eight PAP patients were treated by whole-lung lavage.The changes of above parameters were compared.The statistical analysis was performed using T test,nonparametric test and linear regression.Results The VRI parameters of the PAP group were as follows:graph grades 0.50(0.00～ 2.75),dynamic image grades 1.50 ( 1.00 ～ 2.00),MEF grades 3.00 ( 1.25 ～3.75),QLD (46.67±8.52)％(right).The VRI parameters of the control group were as follows:graph grades 0.00(0.00 ～ 1.00 ),dynamic image grades 0.00 ( 0.00 ～ 1.00 ),MEF grades 1.00 ( 0.00 ～ 1.50 ),QLD (43.30±6.02)％ (right).There was significant difference between the two groups in dynamic image grades and MEF grades ( P ＜0.05),no significant difference was shown in graph grades and QLD.Eight PAP patients accepted the whole-lung lavage treatment.Before treantment,the patients' VR1 parameters were as follows:graph grades 1.50(0.00～3.50),dynamic image grades 1.50( 1.00～2.00),MEF grades 3.00(1.25～4.75),rale grades 1.00(0.25～1.00),MEF areas (68.62±4.59) kilo-pixels and the whole grades of image 6.00(4.25 ～ 9.00).After lavage treatment,these parameters were as follows:graph grades 0.50 (0.00 ～ 1.75),dynamic image grades 1.00 ( 1.00 ～ 1.00),MEF grades 1.00 (0.00 ～ 1.75),rale grades 0.50(0.00 ～ 1.00),MEF areas ( 71.66 ± 6.03) kilo-pixels,the whole grades of image 3.00 (2.00～3.75).There were significant differences in MEF grades,MEF areas and the whole grades of image ( P ＜0.05),otherwise graph grades,dynamic image grades and rale grades were not.After treatment,there was no linear correlation between the improvement in oxygenation index and VRI image grades' changes.Conclusions PAP patients' MEF areas become larger,MEF appearances are better after the whole-lung lavage treatment.VRI will be used in following up PAP patients.