CT肺动脉造影测定脊柱室间隔角评价慢性血栓栓塞性肺动脉高压肺血管阻力的价值探讨  

The Relation Between Spinal Ventricular Septal Angle by Computer Tomographic Pulmonary Angiography and Pulmonary Vascular Resistance in Chronic Thromboembolic Pulmonary Hypertension

作　　者：刘敏[1] 马展鸿[1] 郭晓娟[1] 邝土光[2] 杨媛华[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]北京朝阳医院呼吸病研究所北京100020

出　　处：《中国呼吸与危重监护杂志》2012年第4期382-386,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家“十一五”科技支撑计划项目(编号:2006BAI01A06)

摘　　要：目的以肺动脉造影及右心导管为标准,采用多层螺旋计算机断层扫描肺动脉造影(CTPA)测定脊柱室间隔角,分析脊柱室间隔角与血流动力学的关系,探讨脊柱室间隔角在评价慢性血栓栓塞性肺动脉高压(CTEPH)血流动力学的价值。方法回顾性纳入2006年1月至2010年6月确诊CTEPH的患者89例(男57例,女32例),年龄(53.08±12.43)岁,并随机选取最终经临床证实无肺栓塞及肺动脉高压的89例患者为对照组。所有CETPH患者均于右心导管检查前1～2 d内行CTPA检查。2名放射科医师共同根据CTPA图像测定CT肺动脉栓塞指数(采用Qanadli肺栓塞指数和Mastora肺栓塞指数)及其脊柱室间隔夹角。结果 CTEPH患者脊柱室间隔夹角为65.13°±12.26°,对照组脊柱室间隔夹角为39.69°±5.84°,两组存在显著差异(t=14.479,P=0.000)。CTPEH患者Qanadli栓塞指数为(42.50±17.67)%,Mastora栓塞指数为(30.02±15.53)%。脊柱室间隔夹角与Qanadi栓塞指数(r=0.094,P=0.552)及Mastora栓塞指数无显著相关性(r=0.025,P=0.873)。Spearman相关分析显示脊柱室间隔夹角与肺血管阻力呈中度正相关(r=0.529,P=0.000),与右房压呈弱正相关(r=0.270,P=0.010),与末梢血氧饱和度、肺动脉收缩压、舒张压及平均肺动脉压、肺毛细血管嵌压无显著相关性(P>0.05)。ROC曲线显示脊柱室间隔角为67.55°时,对估测肺血管阻力(PVR)≥1000 dyne.s.cm-5的诊断灵敏度为0.714,特异度为0.778,ROC曲线下面积为0.764。结论脊柱室间隔夹角能够较好地反映CTEPH患者的PVR变化,对评价CTPEH具有重要的参考价值。Objective To investigate the relation of spinal ventricular septal angle （SVSA） measured by computer tomographic pulmonary angiography （CTPA） and pulmonary vascular resistance （PVR） measured by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension （CTEPH）. Methods Eighty-nine patients with CTEPH （ male 57, female 32 ; 53.08 ＋12.43 years） were recruited as a CTEPH group, and 89 patients without pulmonary artery hypertension and pulmonary embolism were recruited as a control group. The CTEPH patients received CTPA before right-heart catheterization and pulmonary angiography. SVSA and pulmonary artery obstruction indexes including Qanadli Index and Mastora index were evaluated by two radiologists. Results SVSA was 65.13° ＋12. 26° and 39. 69° ＋ 5.84° in the CTEPH group and the control group respectively, with significant difference between two groups （t = 14. 479, P = 0. 000 ）. Qanadli index of the CTEPH patients was （42. 50 ±17.67 ）%, which had no correlation with SVSA （ r = 0. 094, P = 0. 552 ）. Mastora index was （ 30. 02± 15.53 ） % , which also had no correlation with SVSA （ r = 0. 025, P = 0. 873 ）. SVSA had a moderate positive correlation with PVR （ r = 0. 529, P = 0. 000） and a weak positive correlation with right atrium pressure （ r = 0. 270, P = 0. 010 ）. Area under ROC was 0. 764 and sensitivity, speeifieity for PVR t〉 1000 dyne · s·cm^-5 was 0. 714 and 0. 778 respectively when SVSA ≥67.55°. Conclusion SVSA measured by CTPA can be used as a better predictor for evaluating PVR in CTEPH patients.

关 键 词：慢性血栓栓塞性肺动脉高压 计算机断层肺动脉造影 脊柱室间隔夹角 肺血管阻力 

分 类 号：R816.2[医药卫生—放射医学]