X线第一前肋间肺静脉直径与肺毛细血管嵌压的关系及对心力衰竭诊断价值探讨  

Correlation between pulmonary vein diameter in the first anterior interspace and pulmonary capillary wedge pressure and clinical significance

作　　者：赵思勤[1] 游长久[2] 胡咏梅[1] 李秋[1] 聂晓莉[1] 张宗建[2] 刘小蓉[1] 王勉[1] 张文勇[1] 吴涛[1] 

机构地区：[1]成都市第二人民医院心内科,四川成都610017 [2]成都市第二人民医院影像科,四川成都610017

出　　处：《中国介入影像与治疗学》2008年第4期273-277,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨X线第一前肋间肺静脉直径（PVDFAI）与肺毛细血管嵌压（PCWP）的关系及对心力衰竭（CHF）的诊断价值。方法人选住院呼吸困难患者195例，正常健康组67例，测定肺毛细血管嵌压（PCWP）并行后前位X线胸片检查，测量PVDFAI。以PCWP〉12mmHg作为左心功能不全的诊断标准，将患者分为心衰组和肺源性呼吸困难组。计算PVDFAI诊断心衰的不同截值的敏感性、特异性、准确性。结果正常对照组PVDFAI（1.34±0．49）mm与肺源性呼吸困难组PVDFAI（1．43±0．37）mm差异无显著统计学意义（q=0．2700，P〉0．05）。心源性呼吸困难组PVDFAI（2．49±0．93）mm与肺源性呼吸困难组和正常对照组比较均有明显增宽（q=17．0676，P〈0．01；q=15．1143，P〈0．01）。PVD-FAI与PCWP密切相关（r=0．388，P=0．000）。多元Logistic回归分析表明胸片PVDFAI是CHF的独立预测因子（P=0．000，比数比28．103）。PVDFAI判定肺源性呼吸困难或心衰，其曲线下面积95．24％（95％可信区间，91．73％～98．85％）。判断左心功能不全的PVDFAI最佳截值为2．5mm，其诊断左心功能不全的敏感度97．17％，特异度93．26％，准确度95．38％。结论第一前肋间肺静脉直径可用以识别有、无肺静脉高压，对诊断心衰有价值。Objective To evaluate correlation between pulmonary vein diameter in the first anterior interspace （PVDFAI） and pulmonary capillary wedge pressure （PCWP） and their clinical significance. Methods PCWP was measured with a Swan-Ganz in 195 patients with presenting dysnpea and a posteroanterior chest radiograph was obtained by using a 1.8 m target-to-film distance in all patients, including the group of normal health （n= 67）. PVDFAI was measured according to standard techniques blinded to PCWP results. PCWP〉 12 mmHg was chosen as the golden standard for left ventricular dysfunction in the study. The subjects were divided into 2 groups by the criteria, one group with dyspnea due to congestive heart failure （CHF, n= 134） and the other due to lung diseases （n=61）. Results The group of normal health （n=67） had PVDFAI widths of （1.34±0.49） mm, not significantly different from the group of patients with pulmonary dyspnea whose PVDFAI was （1.43±0.37 mm, q=0. 2700, P〈0.05）. The group of patients with CHF had PVDFAI widths of （2.49± 0.93） ram, wider than that of pulmonary dyspnea group （q= 15. 1143,P〈0.01） and the group of normal health （q= 17. 0676, P〈0.01）. PVDFAI widths was the single most accurate predictor of the presence or absence of CHF （P= 0. 000, Odds Ratio= 28. 103）. When PVDFAI was used to differentiate CHF from pulmonary disease of dyspnea, the area under the receiver operating curve （ROC） was 95. 24% （95%confidence interval, 91. 73%-98. 85%）. PVDFAI widths cutoff point of 2.5 mm had a sensitivity of 97. 17%, a specificity of 93. 26%, an accuracy of 95. 38% for differentiating CHF from pulmonary disease of dyspnea. PVDFAI widths of 2.5 mm was the cutoff point in the diagnosis of CHF. Conelusion The recognition of pulmonary venous hypertension is the pulmonary vein diameter in the first anterior interspace, and PVDFAI should be of help to diagnose CHF.

关 键 词：心力衰竭 充血性 呼吸困难 血流动力学 X线摄影 

分 类 号：R541.61[医药卫生—心血管疾病] R816.2[医药卫生—内科学]