【摘要】 目的：研究呼吸门控定量CT在评估矽肺功能中的价值。方法：选取医院诊治的80例矽肺患者，所有患者均符合国家《职业性尘肺病的诊断》标准。根据患者胸片检查中肺部阴影情况将阴影直径1～10 mm的患者纳入单纯矽肺组(49例)，将存在直径>10 mm大阴影的患者纳入复杂矽肺组(31例)，对比评价两组患者年龄、性别、有无吸烟史、硅暴露时间，采用呼吸困难程度的博格(Borg)评分量表评价呼吸困难程度，并对两组患者肺功能检测及不同呼吸时相的CT检查图像进行评估。分析观察者对两组患者的吸气图像、病变程度和大阴影总面积评分的一致性；对两组患者肺功能结果与CT指标进行Spearman秩相关性分析。结果：复杂矽肺组与单纯矽肺组患者的年龄、硅暴露时间、Borg评分比较，差异均无统计学意义(t=1.835,t=2.193,t=2.209;P>0.05)，性别和有无吸烟史比较，差异均无统计学意义(x2=3.053,x2=1.032;P>0.05)。两名观察者之间对两组患者小阴影的影像学表现以及空气滞留、肺气肿、支气管扩张和矽肺结节CT评分(5项内容)具有良好的一致性(r=0.765,r=0.910,r=0.859,r=0746,r=0.861;P<0.001)；且对CT图像上的小阴影和大阴影的影像学分类的一致性极好(Kappa=1.000，加权Kappa=0.816;P<0.001)，并对网格影评分的一致性良好(加权Kappa=0.686,P<0.001)。复杂矽肺组患者大阴影CT图像评分显著高于单纯矽肺组患者，差异有统计学意义(t=5.184,P<0.001)。呼气末20%肺活量(20%VC)两组间像素指数(PI910)差异有统计学意义(t=2.411,P<0.05)。复杂矽肺组患者的第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1与FVC之比(FEV1/FVC)值均显著低于单纯矽肺组患者，差异有统计学意义(t=3.485,t=2.991,t=3.302;P<0.05)。PI910(呼气末)、空气滞留CT评分、肺气肿CT评分与FEV1/FVC相关性最强(r=0.726,r=-0.823,r=-0.746;P<0.05)。网格影CT评分与FEF75%、FEF50%和FEF25%呈弱正相关(r=0.387,r=0.394,r=0.371;P<0.05)，但与FEV1/FVC无相关性。矽肺结节、支气管扩张和大阴影CT评分与肺功能检测结果无相关性。结论：空气滞留和PI910(呼气末)与气流受限相关肺功能的相关性最强，在CT影像评分基础上同时结合呼吸门控定量CT技术可能有助于矽肺功能的评价。更多还原

【Abstract】 Objective: The purpose of this study was to investigate the application value of respiratory gating quantitative computed tomography(CT) in the assessment of pulmonary function in patients with silicosis. Methods: A total of 80patients with silicosis who admitted to hospital were collected. All patients met the criteria of "Diagnosis of occupational pneumoconiosis(GBZ 70-2015)", and they were divided into single silicosis group(49 cases) of patients whose shadow diameters were between 1-10 mm, and complex silicosis group(31 cases) of patients who occurred big shadow according to the situation of shadow in lung. The age, gender, with or without smoking history, the exposure duration of Silicon and Borg score scale of two groups were compared so as to evaluate the degree of breathing difficulties. The CT examination images of lung function detection and different respiratory time phase of two groups were assessed. The consistencies of observers on the images of inspiration, the degree of lesion and the total area of big shadow of two groups were analyzed.The Spearman rank correlation analysis was performed between pulmonary function results and CT indexes of two groups of patients. Results: There were no significant differences in age(t=1.835, P>0.05), gender(x2=3.053, P>0.05), smoking history(x2=1.032, P>0.05), exposure time of Silicon(t=2.193, P>0.05), and Borg score(t=2.209, P>0.05) of perceived dyspnea of patients between the complex silicosis group and the simple silicosis group. There were favorable consistencies between the imaging findings of small shadows and the CT scores of air trapping, emphysema, bronchiectasis and silicosis nodule of two groups of patients as the observation of two observers(r=0.765, r=0.910, r=0.859, r=0746, r=0.861,P<0.001). Moreover, the consistencies of imaging classification of small shadow and large shadow on CT images of two observers were excellent(Kappa=1.000, weighted Kappa=0.816, P<0.001), and the consistency of the score of gridding shadow was favorable(weighted Kappa=0.686, P<0.001). The scores of CT image of large shadow of complex silicosis group was significantly higher than that of single silicosis group, and the difference of that was statistically significant(t=5.184,P<0.001). The difference of the pixel index(PI910) of 20% vital capacity(20% VC) at end of expiration between two groups was significant(t=2.411, P<0.05). The values of forced expiratory volume at the first second(FEV1), forced vital capacity(FVC) and the ratio of FEV1/FVC in complex silicosis group of patients were significantly lower than those in single silicosis group of patients(t=3.485, t=2.991, t=3.302, P<0.05), respectively. PI910(at end of expiratory), CT score of air retention and CT score of emphysema had the strongest correlation with FEV1/FVC(r=0.726, r=-0.823, r=-0.746, P<0.05). The CT score of gridding image appeared weakly positive correlations with FEF75%, FEF50% and FEF25%(r=0.387, r=0.394, r=0.371,P<0.05), but it was no correlation with FEV1/FVC. The CT scores of silicosis nodule, bronchiectasis and large shadow were not correlation with test results of lung function. Conclusion: Air retention and PI910(at end of expiratory) have the strongest correlation with airflow restriction-related lung function. On the basis of the score of CT image, the combined respiratory gating quantitative CT technique may be helpful in evaluating the function of silicosis.更多还原