CT肺动脉成像评价慢性血栓栓塞性肺动脉高压栓塞指数及右心功能  

Right ventricular function and pulmonary obstruction index evaluation by computer tomographic pulmonary angiography in patients with chronic thromboembolic pulmonary hypertension

作　　者：刘敏[1] 马展鸿[1] 郭晓娟[1] 杨媛华[2] 谢万木[2] 王辰[2] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020 [2]首都医科大学附属北京朝阳医院呼吸病研究所,北京100020

出　　处：《医学影像学杂志》2010年第6期804-808,共5页Journal of Medical Imaging

基　　金：国家"十一五"科技支撑计划项目(编号:2006BAI01A06);首都医科大学基础临床合作研究项目(编号:2007JL25);首都医科大学附属北京朝阳医院青年基金项目(编号:2009-22)

摘　　要：目的:以选择性肺动脉造影及右心导管为标准,探讨多层螺旋计算机断层肺动脉成像(CTPA)评价慢性血栓栓塞性肺动脉高压(CTEPH)及右心功能的价值。方法:回顾性收集确诊CTEPH的患者24例,均行右心导管及肺动脉造影、CTPA及超声心动图检查。结果:CT Qanadli栓塞指数为(37.16±8.77)%,CT Mastora栓塞指数为(38.14±21.56)%,Qanadli栓塞指数高于Mastora栓塞指数(Z=-4.107,P=0.000),且二者正相关(r=0.734,P=0.000)。CTPA测得主肺动脉/升主动脉直径比与右心导管测定肺动脉平均压(mean pulmonary arterial pressure,mPAP)正相关(r=0.461,P=0.036)。CTPA测定右心室前壁厚度与mPAP成正相关(r=0.515,P=0.018)。CTPA测得肺动脉直径大于超声测肺动脉内径(t=3.485,P=0.002),且正相关(r=0.588,P=0.002)。CTPA测得右心室最大短轴直径大于超声测右室横径(t=2.647,P=0.016),且正相关(r=0.429,P=0.031)。CTPA测定右室前壁厚度小于超声测值(t=3.768,P=0.001),且成正相关(r=0.551,P=0.004)。CTPA测室间隔厚度略低于超声测室间隔厚度(t=2.941,P=0.007),两组资料正相关(r=0.751,P=0.000)。Qanadli栓塞指数和Mastora栓塞指数与肺动脉压、主肺动脉直径、肺动脉/主动脉直径比、右室横径、右室前壁厚度等参数均无相关性(P>0.05)。结论:CT肺动脉造影不仅能够明确诊断慢性血栓性肺栓塞,而且能够提供肺动脉树的阻塞程度、右心功能改变信息,为临床决策和治疗提供更多的信息,但慢性血栓性肺动脉高压肺栓塞程度与右心功能无关。Objective：The aim was to investigate the relation between pulmonary artery obstruction index and right ventricular function secondary to chronic thromboembolic pulmonary hypertension（CTEPH）.Methods：CTPA performed on 24 patients with CTEPH from January 2006 to March 2008 were retrospectively reviewed.All patients received CTPA and echocardiogram before right-heart catheterization and pulmonary angiography.Pulmonary artery obstruction indexes（PAOI） were assessed with Qanadli index and Mastora index with CTPA.Results：Qanadi PE index（37.16±8.77）% had a significantly difference with Mastora PE index（38.14±21.56）%（Z=-4.107,P=0.000） and with a positive correlation（r=0.734,P=0.000）.The ratio of main pulmonary artery diameter with ascending main artery diameter by CTPA significantly correlated with mean pulmonary artery pressure（52.55±10.13） mm by right heart catheterization（r=0.461,P=0.036）.Right ventricular anterior wall thickness（7.49±2.25） mm significantly correlated with mean pulmonary artery pressure（r=0.515,P=0.018）.The diameter of pulmonary artery by CTPA positively correlated with the value form echocardiography（r=0.588,P=0.002）.The right ventricular maximum short axis diameter by CTPA correlates with transverse diameter of right ventricular（r=0.429,P=0.031）.Right ventricular anterior wall thickness by CTPA correlated with the value measured by echocardiography（r=0.515,P=0.018）.The thickness of interventricular septum by CTPA was a significantly correlation with value from echocardiography（r=0.751,P=0.000） Whether Qanadli index or Mastora index had no significantly correlation with the right heart function （P〉0.05）.Conclusion：CTPA can supply both the extent of pulmonary artery obstruction and right ventricular function,but there is no correlation between pulmonary artery obstruction indexes and right ventricular function in CTEPH.

关 键 词：慢性血栓栓塞性肺动脉高压 CT肺动脉造影肺动脉栓塞指数 右心功能 

分 类 号：R543.2[医药卫生—心血管疾病] R814.42[医药卫生—内科学]