Nghiên cứu giá trị của chụp cắt lớp vi tính 128 định lượng trên bệnh nhân bệnh phổi tắc nghẽn mạn tính trước và sau ghép tế bào gốc tự thân

SUMMARY

Background: Quantitative Computed Tomography (QCT) has been used for many years worldwide to evaluate and quantify lung parenchymal lesions in chronic obstructive pulmonary disease (COPD), including emphysema quantification (LAA-950), air-trapping assessment area (LAA- 856), bronchial wall area (WA), percentage of wall area (% WA), bronchial lumen area (LA), bronchial wall thickness (WT), studies show that QCT is highly accurate, strongly correlated with the respiratory function test (FEV1, FVC), grade classification according to GOLD. We applied this method to evaluate the indicators of emphysema (LAA-950), air-trapping (LAA-856), RVC¬856-950, bronchial wall area (WA), bronchial lumen (LA) and bronchial wall thickness (WT), percentage pulmonary vascular (%HAV) of COPD patients before and after autologous stem cell transplant from adipose tissue and bone marrow.

Method: The study was conducted from 10.2019 - 10.2020 on 32 COPD patients diagnosed with COPD according to GOLD 2018 standards, patients with FEV1 <60% were selected for the autologous stem cell transplant study at The Respiratory Center - Bach Mai Hospital (4 GOLD II patients, 17 GOLD III patients, 11 GOLD IV patients). The patient was given quantitative CT scans 2 times, the first time before transplant and the second after 6 months after transplantation with a 128-detectors scanner of Siemens (Somatom Definition Egde) at Dien Quang Center - Bach Mai Hospital.

Results: Percentage of emphysema (LAA-950) before grafting 31.49% ± 8.19, after grafting 32.8% ± 7.13), percentage of air-trapping in then exhalation (LAA-856) before grafting 63.65% ± 8.74, after transplant 61.41% ± 7.4 (statistically significant difference p = 0.026), RVC856- 950 before transplant 0.83 ± 1.82, post transplant 3.58 ± 1.76 (significant difference p = 0.000), these indicators are linearly correlated with FEV1, BODE and GOLD classification. The percentage of wall area (%WA) after transplantation was changed in the bronchial branch of segment 1 (70.74% before transplantation, 67.59% after transplantation, p = 0.02) and in branch of subsegment 1 (79.19% before transplantation, after transplantation 75.90%, p = 0.01), lumen area (LA), inner diameter (ID) of the posttransplant bronchial all increased in the segmental and subsegmental bronchial branches RB1, RB4, RB10, wall thickness (WT) decreased in the sub-branches RB1-1, RB4-1, RB10-1 (however the difference was not statistically significant with p <0.05).

Conclusion: Emphysema (LAA-950), air-trapping (LAA-856, RVC856-950), percentage of bronchial wall (% WA), lumen area (LA), inner diameter (ID), thickness bronchial wall (WT) measured on QCT correlated with FEV1, FVC, GOLD, BODE before and after stem cell transplantation, can be used to assess the extent and stage of Chronic Obstructive Pulmonary Disease, pre- and post-assessment of autologous stem cell transplant therapy.

Keywords: Quantitative CT COPD, Quantitative CT after autologous stem cell tranplantation