CT肺动脉造影评价慢性血栓栓塞性肺动脉高压的血流动力学  

CT Pulmonary Angiography in the Assessment of Hemodynamic Change of Chronic Thromboembolic Pulmonary Hypertension

作　　者：马展鸿[1] 刘敏[1] 郭晓娟[1] 张红霞[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介入放射科,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：《实用放射学杂志》2010年第9期1254-1258,共5页Journal of Practical Radiology

基　　金：基金项目：国家“十一五”科技支撑计划项目（编号：2006BA101A06）;首都医科大学基础临床合作研究项目（编号：2007JL25）.

摘　　要：目的 探讨多层螺旋CT肺动脉造影 （CT pulmonary angiography,CTPA）与慢性血栓性肺动脉高压血流动力学关系.方法 回顾性纳入2006-01-2009-10慢性肺栓塞患者55例,评价CT肺动脉栓塞指数（CT pulmonary artery obstruction index, CTPAOI）及CTPA参数.根据CTPA图像采用Qanadli栓塞指数和Mastora栓塞指数计算 CTPAOI.CTPA参数均在轴位图像测量,包括主肺动脉直径、主肺动脉与升主动脉直径比、右室左室直径比等.结果 55例CTEPH患者Qanadli栓塞指数为（37.60±15.22）%,Mastora栓塞指数为（30.02±16.43）%,Qanadli 栓塞指数高于Mastora栓塞指数, Z=-6.296,P=0.000 但二者显著正相关,r =0.875,P=0.000.无论Qanadli栓塞指数还是Mastora栓塞指数与血流动力学参数之间均无显著相关性（P〉0.05）.CTPA参数与血流动力学参数相关分析显示右室左室直径比与肺动脉收缩压（r=0.240,P=0.021）、肺动脉舒张压（r=0.255,P=0.014）、平均肺动脉压（r=0.217,P=0.037）、肺毛细血管嵌压（r=0.318,P=0.002）、肺血管阻力（r=0.369,P=0.000）呈正相关 右肺动脉干直径、右室与左室比、右室前壁厚度为平均肺动脉压的独立因素.结论 采用Qanadli栓塞指数和Mastora栓塞指数不能反映慢性血栓性肺动脉高压血流动力学变化,但CTPA参数能够从不同方面反映血流动力学状态.Objective To investigate the correlation of CT pulmonary artery obstruction index[CTPAOI）. CTPA parameters and haemodynamics in the patients with chronic thromboembolic pulmonary hypertension（CTEPH）. Methods Fifty five patients with CTEPH （30 men and 25 womon） ,from January 2006 to October 2009, were retrospectively reviewed. All patients received CT pulmonary angiography before right--heart catheterization and pulmonary angiography. CTPAOIs were assessed with Qanadli index and Mastora index. Results Among 55 patients,Qanadi index was {37.60±15.22）% and Mastora index was（30.02±16.43）% ,there was significantly difference （Z= - 6. 296, P = 0. 000 ） and positive correlation （ r= 0. 875, P = 0. 000 ） between them. Neither Qanadli index nor Mastora index had significant correlation with haemodynamic data （P〉0.05） by Spearman correlation. The ratio of right ventrieular diameter and left ventrieular diameter （ RVd/LVd ） positively correlated with pulmonary arterial systolic pressure （r = 0. 240, P = 0.021 ）, pulmonary artery diastolic pressure（ r= 0.255, P = 0. 014 ）, mean pulmonary artery pressure （ mPAP r= 0.217, P = 0. 037 ）, pulmonary capillary wedge pressure（r= 0. 318, P= 0. 002 ） and pulmonary vascular resistance （ r = 0. 369 , P = 0. 000 ）By stepwise linear regression analysis,right pulmonary artery diameter , RVd/LVd , right ventricular anterior wall thickness were shown to be independently associated with mPAP . Conclusion Neither Qanadli index nor Mastora index at CTPA has correlation with haemodynamic data in CTEPH . CTPA parameters can reflect the haemodynamics , in which RVd/ I.Vd is a better parameter. RPAd. RVd/LVd and RVAWT are showed to be independently associated with mPAP in CTEPH.

关 键 词：肺 血栓 肺动脉高压 动脉造影 体层摄影 X线计算机 血流动力学 

分 类 号：R543.2[医药卫生—心血管疾病] R814.43[医药卫生—内科学]