多层螺旋CT联合血清Vanin-1水平预测COPD患者预后的临床价值

doi:10.3969/j.issn.1004-583X.2025.04.008

摘要/Abstract

摘要：

目的探究多层螺旋CT(multi-slice CT, MSCT)扫描参数、血管非炎性分子1(vascular non-inflammatory molecule 1, Vanin-1)水平联合检测对慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)稳定期患者预后的预测价值。方法纳入2021年4月-2024年1月于我院就诊的137例COPD稳定期患者为研究组,另选取同期137例体检健康者为对照组。比较2组、不同病情程度亚组和不同预后亚组间MSCT扫描参数[深呼气末肺气肿指数(EIex)、肺小血管与肺截面积百分比<5 mm²(%CSA<5)、深呼气末的全肺容积(Vex)、全肺容积(Vin)、容积差(Vin-Vex)、全肺深呼气末肺像素指数(PIex)]、血清Vanin-1水平。采用Spearman分析相关性探究MSCT扫描参数、血清Vanin-1水平与患者预后的相关性,绘制受试者工作特征曲线分析其对患者预后的预测价值。结果研究组Vex、PIex、EIex和血清Vanin-1水平均高于对照组,Vin、%CSA<5百分比和Vin-Vex均低于对照组,差异均有统计学意义(P<0.05)。轻度组Vin、Vin-Vex和%CSA<5均高于中度组和重度组,中度组Vin、Vin-Vex、%CSA<5均高于重度组;轻度组Vex、PIex、EIex及血清Vanin-1水平均低于中度组和重度组,中度组Vex、PIex、EIex及血清Vanin-1水平均低于重度组,差异均有统计学意义(P<0.05)。Vin、Vin-Vex、%CSA<5与病情程度呈负相关,Vex、PIex、EIex及血清Vanin-1水平与病情程度呈正相关,差异均有统计学意义(P<0.05)。预后不良组Vex、PIex、EIex及血清Vanin-1水平均高于预后良好组,Vin、Vin-Vex、%CSA<5低于预后良好组,差异均有统计学意义(P<0.05)。以预后不良者为阳性样本,预后良好者为阴性样本,绘制受试者工作特征曲线,结果显示,Vin、Vin-Vex、%CSA<5、Vex、PIex、EIex及血清Vanin-1水平联合预测预后的曲线下面积为0.911,敏感度为92.66%,特异度为82.14%。结论 MSCT扫描参数、血清Vanin-1水平均与COPD患者病情程度相关,二者联合检测可为临床预测COPD患者预后提供有效参考依据。

关键词: 肺疾病, 慢性阻塞性, 体层摄影术, 螺旋计算机, 血管非炎性分子1, 联合检测, 预测价值

Abstract:

Objective To explore the predictive value of multi-slice spiral computed tomography CT (MSCT) scanning parameters combined with serum vascular non-inflammatory molecule 1 (Vanin-1) in predicting the prognosis of chronic obstructive pulmonary disease (COPD) in the stable stage. Methods A total of 137 patients with stable COPD who were treated from April 2021 to January 2024 were included in the study group, and 137 healthy subjects who underwent physical examination during the same period were selected as the control group. The MSCT scanning parameters (emphysema index at the end of deep expiration [EIex], percentage of pulmonary small vessels and lung cross-sectional area<5 mm² [%CSA<5], whole lung volume at the end of deep expiration [Vex], whole lung volume [Vin], volume difference [Vin-Vex], whole lung pixel index at the end of deep expiration [PIex]) and serum Vanin-1 level were compared. Spearman correlation analysis was used to explore the correlation of MSCT scanning parameters, and serum Vanin-1 level with the prognosis of COPD, and the receiver operating characteristic (ROC) curve was drawn to analyze its predictive value for the prognosis. Results The levels of Vex, PIex, EIex and serum Vanin-1 in the study group were significantly higher than those of the control group, and Vin, %CSA<5 and Vin-Vex were significantly lower (P<0.05). Vin, Vin-Vex and %CSA<5 in the mild group were significantly higher than those of the moderate group and the severe group, which, in the moderate group were significantly higher than those of the severe group (P<0.05). The levels of Vex, PIex, EIex and serum Vanin-1 in the mild group were significantly lower than those of the moderate group and the severe group, which were significantly lower in the moderate group than the severe group (P<0.05). The levels of Vin, Vin-Vex and %CSA<5 were negatively correlated with the severity of COPD, and the levels of Vex, PIex, EIex and serum Vanin-1 were positively correlated with the severity COPD (P<0.05). The levels of Vex, PIex, EIex and serum Vanin-1 in the poor prognosis group were significantly higher than those of the good prognosis group, and the levels of Vin, Vin-Vex and %CSA<5 were significantly lower in the good prognosis group (P<0.05). The ROC curve was drawn with patients with poor prognosis as positive samples and those with good prognosis as negative samples. It is found that the area under the curve (AUC) of Vin, Vin-Vex, %CSA<5, Vex, PIex, and EIex combined with serum Vanin-1 levels in predicting the prognosis of COPD was 0.911, with the sensitivity of 92.66%, and the specificity of 82.14%. Conclusion The MSCT scanning parameters and serum Vanin-1 level are closely correlated with the severity of COPD patients, and their combined detection can provide effective reference sfor clinical prediction of the prognosis of COPD.

Key words: pulmonary disease, chronic obstructive, tomography, spiral computed, vascular non-inflammatory molecule 1, combined detection, predictive value

中图分类号:

R563.9

张森, 张新生, 王东祥. 多层螺旋CT联合血清Vanin-1水平预测COPD患者预后的临床价值[J]. 临床荟萃, 2025, 40(4): 339-343.

Zhang Sen, Zhang Xinsheng, Wang Dongxiang. Clinical significance of multi-slice spiral computed tomography combined with serum Vanin-1 levels in predicting the prognosis of chronic obstructive pulmonary disease[J]. Clinical Focus, 2025, 40(4): 339-343.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.04.008

https://lchc.magtechjournal.com/CN/Y2025/V40/I4/339

图/表 7

表1 两组MSCT扫描参数、血清Vanin-1水平比较

Tab.1 Comparison of MSCT scanning parameters and serum Vanin-1 level between groups

组别	例数	Vin(L)	Vex(L)	Vin-Vex(L)	PIex	EIex(%)	%CSA<5(%)	Vanin-1(ng/ml)
研究组	137	5.03±0.84	2.39±0.58	2.34±0.43	23.97±8.11	27.23±5.26	0.59±0.13	2.54±0.26
对照组	137	7.19±0.94	1.25±0.31	4.79±0.76	13.06±4.21	16.37±2.16	0.85±0.21	0.75±0.14
$t$ 值		20.055	20.290	32.840	13.975	22.355	12.322	70.950
P值		0.000	0.000	0.000	0.000	0.000	0.000	0.000

表1 两组MSCT扫描参数、血清Vanin-1水平比较

Tab.1 Comparison of MSCT scanning parameters and serum Vanin-1 level between groups

组别	例数	Vin(L)	Vex(L)	Vin-Vex(L)	PIex	EIex(%)	%CSA<5(%)	Vanin-1(ng/ml)
研究组	137	5.03±0.84	2.39±0.58	2.34±0.43	23.97±8.11	27.23±5.26	0.59±0.13	2.54±0.26
对照组	137	7.19±0.94	1.25±0.31	4.79±0.76	13.06±4.21	16.37±2.16	0.85±0.21	0.75±0.14
$t$ 值		20.055	20.290	32.840	13.975	22.355	12.322	70.950
P值		0.000	0.000	0.000	0.000	0.000	0.000	0.000

图1 COPD稳定期患者MSCT影像学图片注:1a.定位:患者桶状胸,肺气肿; 1b. 横断位:肺纹理纤细,肺野透亮度增强,多发囊状透亮影; 1c.正中冠状位:下肺野远端支气管稍增宽,肺野多发囊状透亮影; 1d.失状位:局部支气管壁毛糙,边缘小叶间隔,局部增厚

Fig.1 MSCT imaging images of patients with stable COPD Fig.1a. Localization: barrel chest, and emphysema; Fig.1b. Fine lung texture, enhanced lung field translucency, and multiple cystic translucency in the transverse view; Fig.1c. Slightly widened distal bronchus of lower lung field, and multiple cystic translucency in the median coronal view; Fig.1d. Rough local bronchial wall, marginal lobular septum, and local thickening in the sagittal view

表2 不同病情程度患者MSCT扫描参数、血清Vanin-1水平比较

Tab.2 Comparison of MSCT scanning parameters and serum Vanin-1 level in patients with different severities of COPD

组别	例数	Vin (L)	Vex (L)	Vin-Vex (L)	PIex	EIex (%)	%CSA<5 (%)	Vanin-1 (ng/ml)
轻度组	45	5.76±0.79	1.79±0.49	3.56±0.59	19.42±6.24	21.63±2.75	0.73±0.26	1.39±0.23
中度组	55	4.89±0.62^#	2.45±0.53^#	2.03±0.38^#	24.85±7.93^#	28.54±4.86^#	0.61±0.18^#	2.71±0.31^#
重度组	37	4.35±0.43^#*	3.03±0.81^#*	1.32±0.34^#*	28.20±8.76^#*	32.09±6.97^#*	0.39±0.11^#*	3.69±0.54^#*
$F$ 值		51.485	42.836	272.067	13.927	47.489	30.957	409.240
P值		0.000	0.000	0.000	0.000	0.000	0.000	0.000

表2 不同病情程度患者MSCT扫描参数、血清Vanin-1水平比较

Tab.2 Comparison of MSCT scanning parameters and serum Vanin-1 level in patients with different severities of COPD

组别	例数	Vin (L)	Vex (L)	Vin-Vex (L)	PIex	EIex (%)	%CSA<5 (%)	Vanin-1 (ng/ml)
轻度组	45	5.76±0.79	1.79±0.49	3.56±0.59	19.42±6.24	21.63±2.75	0.73±0.26	1.39±0.23
中度组	55	4.89±0.62^#	2.45±0.53^#	2.03±0.38^#	24.85±7.93^#	28.54±4.86^#	0.61±0.18^#	2.71±0.31^#
重度组	37	4.35±0.43^#*	3.03±0.81^#*	1.32±0.34^#*	28.20±8.76^#*	32.09±6.97^#*	0.39±0.11^#*	3.69±0.54^#*
$F$ 值		51.485	42.836	272.067	13.927	47.489	30.957	409.240
P值		0.000	0.000	0.000	0.000	0.000	0.000	0.000

表3 MSCT扫描参数、血清Vanin-1水平与病情程度的相关性分析

Tab.3 Correlation of MSCT scanning parameters and serum Vanin-1 level with the severity of COPD

指标	$r s$ 值	P值
Vin	-0.614	0.000
Vex	0.529	0.000
Vin-Vex	-0.483	0.000
PIex	0.596	0.000
EIex	0.647	0.000
%CSA<5	-0.532	0.000
血清Vanin-1	0.625	0.000

表3 MSCT扫描参数、血清Vanin-1水平与病情程度的相关性分析

Tab.3 Correlation of MSCT scanning parameters and serum Vanin-1 level with the severity of COPD

指标	$r s$ 值	P值
Vin	-0.614	0.000
Vex	0.529	0.000
Vin-Vex	-0.483	0.000
PIex	0.596	0.000
EIex	0.647	0.000
%CSA<5	-0.532	0.000
血清Vanin-1	0.625	0.000

表4 不同预后患者MSCT扫描参数、血清Vanin-1水平比较

Tab.4 Comparison of MSCT scanning parameters and serum Vanin-1 levels in patients with different statuses of prognosis

组别	例数	Vin (L)	Vex (L)	Vin-Vex (L)	PIex	EIex (%)	%CSA<5 (%)	Vanin-1 (ng/ml)
预后良好组	28	6.84±1.03	1.75±0.41	3.61±0.52	20.34±4.67	19.58±3.58	0.79±0.18	1.46±0.17
预后不良组	109	4.57±0.64	2.55±0.39	2.01±0.38	24.90±8.36	29.20±5.91	0.54±0.10	2.82±0.31
$t$ 值		14.582	9.582	18.337	2.772	8.221	9.806	22.327
P值		0.000	0.000	0.000	0.006	0.000	0.000	0.000

表4 不同预后患者MSCT扫描参数、血清Vanin-1水平比较

Tab.4 Comparison of MSCT scanning parameters and serum Vanin-1 levels in patients with different statuses of prognosis

组别	例数	Vin (L)	Vex (L)	Vin-Vex (L)	PIex	EIex (%)	%CSA<5 (%)	Vanin-1 (ng/ml)
预后良好组	28	6.84±1.03	1.75±0.41	3.61±0.52	20.34±4.67	19.58±3.58	0.79±0.18	1.46±0.17
预后不良组	109	4.57±0.64	2.55±0.39	2.01±0.38	24.90±8.36	29.20±5.91	0.54±0.10	2.82±0.31
$t$ 值		14.582	9.582	18.337	2.772	8.221	9.806	22.327
P值		0.000	0.000	0.000	0.006	0.000	0.000	0.000

表5 MSCT扫描参数、血清Vanin-1水平对预后的预测价值

Tab.5 Predictive value of MSCT scanning parameters and serum Vanin-1 level for the prognosis of COPD

指标	AUC	95%CI	cut-off值	敏感度(%)	特异度(%)
Vin	0.753	0.672~0.823	<4.79 L	71.56	71.43
Vex	0.766	0.686~0.834	>2.30 L	75.23	75.00
Vin-Vex	0.729	0.647~0.801	<2.29 L	70.64	67.86
PIex	0.771	0.692~0.839	>22.71	72.48	82.14
EIex	0.737	0.655~0.808	>25.77%	76.15	64.29
%CSA<5	0.746	0.665~0.817	<0.6%	78.90	67.86
Vanin-1	0.783	0.704~0.848	>2.66 ng/ml	68.81	75.00
联合诊断	0.911	0.850~0.953	-	92.66	82.14

图2 MSCT扫描参数、血清Vanin-1水平对预后预测价值的ROC曲线

Fig.2 ROC curve of MSCT scanning parameters and serum Vanin-1 level in predicting the prognosis of COPD

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