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目的:探讨双气相定量CT对吸烟合并慢性阻塞性肺疾病（COPD）患者各肺叶小气道病变与肺气肿损伤程度的评估价值。方法:本研究为回顾性研究。收集延安大学附属医院2018年7月至2020年9月接受双气相CT及肺功能（PFT）检查的男性体检者186例，并分为吸烟合并COPD者（COPD组）121例，年龄34~84（64±8）岁；吸烟非COPD者（非COPD组）65例，年龄34~72（61±5）岁。根据COPD全球倡议指南，将COPD组患者分为慢性阻塞性肺疾病全球倡议（GOLD）Ⅰ~Ⅳ级。将CT原始DICOM数据导入“数字肺”测试及分析平台，计算各肺叶的小气道病变区域百分比（fSAD%）、肺气肿区域百分比（Emph%）。采用单因素方差分析或Kruskal-Wallisn H检验比较非COPD组、COPD组各分级间CT定量参数的差异性。采用Spearman分析吸烟指数与CT定量参数间相关性。n 结果:非COPD组与COPD组GOLD Ⅰ~Ⅳ级各肺叶fSAD%、Emph%比较差异均有统计学意义（n P<0.001）。除了COPD组GOLD Ⅰ级右肺中叶Emph%高于GOLD Ⅱ级外，随着COPD组GOLD级别增加，余各肺叶fSAD%、Emph%逐渐增大。不同分级间fSAD%及Emph%，均以右肺中叶及双肺上叶较大。各肺叶间比较显示，除GOLD Ⅳ级的fSAD%、Emph%差异无统计学意义（n P=0.395、0.840）外，余差异均具有统计学意义（n P<0.01）。吸烟指数与各肺叶CT定量指标fSAD%及Emph%均存在正相关（n P<0.001），其中吸烟指数与右肺下叶fSAD%及左肺下叶Emph%相关性较高（n r=0.474、0.619，n P<0.001）。n 结论:双气相定量CT能够早期、敏感地反映吸烟合并COPD小气道病变与肺气肿损伤程度，对COPD早期诊断及演变过程的评估具有重要意义。“,”Objective:To explore the value of biphasic quantitative CT on small airway disease and emphysema injury in patients with smoking combined with chronic obstructive pulmonary disease (COPD).Methods:A total of 186 male physical examination subjects who underwent biphasic CT and pulmonary function (PFT) examinations in the Affiliated Hospital of Yan′an University from July 2018 to September 2020 were enrolled in this retrospective study. These subjects were divided into 121 smokers with COPD (COPD group), aged 34 to 84 (64±8) years old and 65 smokers without COPD (non-COPD group) aged 34 to 72 (61±5) years old. According to the guidelines of the COPD global initiative, patients in COPD group were divided into Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) Ⅰ-Ⅳ grades. The original DICOM data of CT were imported into the “Digital Lung” test and analysis platform. Quantitative parameters of functional small airway disease percentage (fSAD%) and emphysema area percentage (Emph%) of each lobe were calculated. The differences of CT quantitative parameters among non-COPD group and each grade in COPD group were analyzed by One-Way ANOVA or Kruskal-Wallis n H test. The correlation between the smoking index and CT quantitative parameters was analyzed by Spearman correlation analysis.n Results:There were significant differences in fSAD% and Emph% of each lobe among non-COPD group and COPD group GOLD Ⅰ-Ⅳ (n P<0.001). Except that the Emph% in right middle lobe of GOLD grade Ⅰ was higher than that of GOLD grade Ⅱ in COPD group, the fSAD% and Emph% in other lobes increased gradually with the increase of GOLD grade in COPD group. The fSAD% and Emph% were larger in the right middle lobe and both upper lobes of COPD group GOLD Ⅰ-Ⅳ. The comparison among each lobe showed that the differences were statistically significant (n P<0.01), except for the fSAD% and Emph% of GOLD Ⅳ (n P=0.395, 0.840). The smoking index was positively correlated with fSAD% and Emph% in each lung lobe. Among them, smoking index was highly correlated with fSAD% in the lower right lobe and Emph% in the lower left lobe (n r=0.474, 0.619, n P<0.001).n Conclusion:The biphasic quantitative CT can early and sensitively reflect the degree of small airway disease and emphysema injury in smoking combined with COPD, which is of great significance for the early diagnosis and evolution of COPD.