Abstract:

Objective　To analyze the correlations between quantitative CT parameters of lung lobes, serum high-sensitivity C-reactive protein/albumin ratio (HCAR) levels, and the severity and therapeutic efficacy in patients with chronic obstructive pulmonary disease (COPD). Methods　A retrospective study was conducted on 92 patients with COPD admitted to Second Affiliated Hospital of Zhengzhou University from March 2022 to August 2024. The patients were divided into mild (42 cases), moderate (31 cases), and severe groups (19 cases) based on their disease severity. There was no significant difference in general data among the three groups ( all P>0.05 ).The quantitative CT parameters of lung lobes [CT air trapping index (ATI), low attenuation area percentage (LAA%) of the entire lung volume, and wall area percentage (WA%)] and serum HCAR level were compared among the three groups at admission, and their correlations were analyzed. The levels of each indicator were compared among patients with different treatment effects, and partial regression analysis was used to analyze their correlations with treatment effect and their predictive value for ineffective treatment. One way analysis of variance and t test were used for statistical analysis. Results　The ATI, LAA%, WA%, and serum HCAR levels in the three groups were compared, severe group > moderate group > mild group, with statistically significant differences (F=29.049, 211.037, 95.503, and 26.523, all P<0.05); ATI, LAA%, WA%, and serum HCAR were positively correlated with the severity of disease (r=0.622, 0.671, 0.637, and 0.667, all P<0.001). The ATI, LAA%, WA%, and serum HCAR levels in the ineffective patients were higher than those in the effective patients (t=5.537, 14.983, 3.901, and 5.410, all P<0.05); ATI (OR=3.070, 95%CI 1.541-6.117), LAA% (OR=2.534, 95%CI 1.847-3.477), WA% (OR=3.086, 95%CI 1.416-6.727), and serum HCAR levels (OR=4.085, 95%CI 2.441-6.837) were risk factors for ineffective treatment (all P<0.05). The efficacy of combined prediction for ineffective treatment using the parameters of ATI, LAA%, WA%, and serum HCAR levels was 0.912, which was higher than that of each individual parameter (P<0.05). Conclusions　Both quantitative CT parameters of lung lobes and serum HCAR are associated with the severity of the COPD patients' condition and therapeutic effect. The combined detection of ATI, LAA%, WA%, and serum HCAR levels can improve the sensitivity and specificity in predicting the therapeutic effect, with high clinical application value.

Key words:

Chronic obstructive pulmonary disease, Quantitative computed tomography, High-sensitivity C-reactive protein/albumin ratio, Severity of illness, Therapeutic effect

摘要：

目的　分析肺叶定量CT参数、血清超敏C反应蛋白/白蛋白比值（HCAR）水平与慢性阻塞性肺疾病（COPD）患者病情程度及治疗效果的相关性。方法　选取郑州大学第二附属医院2022年3月至2024年8月收治的92例COPD患者进行回顾性研究，根据患者病情程度分为轻度组（42例）、中度组（31例）及重度组（19例）。3组一般资料比较，差异均无统计学意义（均P>0.05）。对比3组入院时肺叶定量CT参数［CT空气潴留指数（ATI）、低衰减区面积百分比（LAA%）、管壁面积百分比（WA%）］及血清HCAR水平，并分析其相关性；对比不同治疗效果患者各指标水平，偏回归分析其与治疗效果的关联性，以及对治疗无效的预测价值。统计学方法采用单因素方差分析、t检验。结果　3组患者ATI、LAA%、WA%及血清HCAR水平比较，重度组>中度组>轻度组，差异均有统计学意义（F=29.049、211.037、95.503、26.523，均P<0.05）；ATI、LAA%、WA%及血清HCAR均与患者病情程度呈正相关（r=0.622、0.671、0.637、0.667，均P<0.001）。治疗无效患者ATI、LAA%、WA%及血清HCAR水平均高于有效患者（t=5.537、14.983、3.901、5.410，均P<0.05）；ATI（OR=3.070，95%CI 1.541～6.117）、LAA%（OR=2.534，95%CI 1.847～3.477）、WA%（OR=3.086，95%CI 1.416～6.727）及血清HCAR水平（OR=4.085，95%CI 2.441～6.837）均为患者治疗无效的危险因素（均P<0.05）。ATI、LAA%、WA%及血清HCAR水平联合预测治疗无效的效能为0.912，高于各指标单独预测。结论　肺叶定量CT参数和血清HCAR均与患者病情程度及治疗效果相关，ATI、LAA%、WA%及血清HCAR水平联合检测可提高预测治疗效果的灵敏度和特异度，具有较高的临床应用价值。

关键词:

慢性阻塞性肺疾病, 定量CT, 超敏C反应蛋白/白蛋白比值, 病情程度, 疗效