急性肺血栓栓塞症患者右心功能不全与栓塞范围的相关性研究  

Related research between right ventricular dysfunction and pulmonary embolism range of the patients with acute pulmonary thromboembolism

作　　者：宋振国[1] 王铁[1] 杨媛华[2] 张镭[3] 吴雅峰[4] 王辰[2] 

机构地区：[1]首都医科大学附属北京朝阳医院核医学科,100020 [2]首都医科大学附属北京朝阳医院呼吸科,100020 [3]首都医科大学附属北京朝阳医院放射科,100020 [4]首都医科大学附属北京朝阳医院超声诊断科,100020

出　　处：《中华核医学杂志》2009年第6期361-364,共4页Chinese Journal of Nuclear Medicine

基　　金：“十五”国家科技攻关计划课题（2001BA703B15）

摘　　要：目的明确急性肺血栓栓塞症（PTE）患者肺栓塞（PE）范围与右心功能不全的关系，探讨利用PE范围诊断右心功能不全的可行性。方法明确诊断为急性PTE的348例患者中，被超声心动图检查诊断为右心功能不全212例和右心功能正常136例。348例急性PTE患者均进行肺通气／灌注（V／Q）显像，用SPSS 11．5软件对PE范围与右心功能进行，检验、直线相关分析及受试者工作特征（ROC）曲线分析。结果PE范围积分（1～36，11．4±7．1）与右心功能不全参数[右心室／左心室前径比值（RVD／LVD）为0．52±0．22、右心室／左心室横径比值（RVTD／LVTD）为0．88±0．26、三尖瓣返流压差（TRPG）为（31．93±21．79）mmHg（1mmHg=0．133kPa）和右心室室壁运动幅度（RVAWM）为（5．77±1．99）mm]呈明显相关（r=0．32，0．45，0．38，-0．37，P均〈0．001），右心功能不全组患者的PE范围（3～36，15．1±6．3）明显高于右心功能正常组（1—15，5．6±3．3；χ^2=445．93，P〈0．001）；PE范围诊断右心功能不全的ROC曲线下面积为0．986，Z〉2．58，P〈0．01。结论PTE患者右心功能状况与栓塞范围明显相关，PE范围对右心功能的诊断具有重要的参考价值。Objective The presence of right ventricular dysfunction （RVD） increases morbidity and mortality of the patient with pulmonary thromboembolism （PTE）. The aims of this study were to evaluate the relation between RVD on echocardiography and pulmonary embolism range on radionuclide pulmonary ventilation-perfusion （V/Q） scan of the patients with acute PTE, and to discuss the diagnostic feasibility of RVD by pulmonary embolism range. Methods All 348 patients with proven PTE were classified as two groups according to the echocardiography diagnosis. Two hundreds and twelve were with RVD and 136 were with normal right ventricular function （N-RVF）. All underwent pulmonary V/Q imaging. Statistical analysis was performed with SPSS 11.5, and the relation between RVD and pulmonary embolism range was performed withx2 analysis, correlation analysis, receiver operating characteristic （ROC） curve analysis. Results Significant relations between RVD （ right/left ventricular end-diastolic diameter ratio （RVD/LVD） = 0.52 ±0. 22, right/left ventricular transverse diameter ratio （RVTD/LVTD） = 0.88 ±0.26, tricuspid regurgitant pressure gradient （TRPG） = （31.93 ±21.79） mm Hg （1 mm Hg =0. 133 kPa） and right ventricular anterior wall motion （RVAWM） = （ 5.77 ±1.99） mm） and pulmonary embolism range （ 1 - 36, 11.4 ±7.1 ） were observed （r = 0.32, 0. 45, 0.38, - 0.37, all P 〈 0. 001 ） ; with significant difference between N- RVF and RVD and larger embolism range in RVD than in N-RVF （χ^2 =445.93, P 〈0. 001 ）. Area under ROC curve with pulmonary embolism range was 0. 986, Z 〉 2. 58, P 〈 0.01. Condusion The pulmonary embolism area was negatively correlated with the RVD and had potential of being one of the references for the impression of RVD in PTE patients.

关 键 词：肺栓塞 血栓栓塞 心室功能 右 放射性核素显像 锝 MAA 

分 类 号：R686[医药卫生—骨科学]