高分辨率CT肺血管指标评估COPD患者肺动脉高压的临床意义  

Clinical significance of evaluating pulmonary hypertension with high resolution CT measurement of pulmonary vascular indexes in chronic obstructive pulmonary disease

作　　者：廖艺璇 王晓华[2] 白宇[1] 林帆[1] 李敏霞[1] 米文君 孙婉璐 陈亚红[1] Liao Yixuan;Wang Xiaohua;Bai Yu;Lin Fan;Li Minxia;Mi Wenjun;Sun Wanlu;Chen Yahong(Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院呼吸与危重症医学科,100191 [2]北京大学第三医院放射科,100191

出　　处：《国际呼吸杂志》2018年第7期502-509,共8页International Journal of Respiration

基　　金：国家自然科学基金（81370141）;国家重点研发计划“重大慢性非传染性疾病防控研究”专项课题（2016YFC1304301）

摘　　要：目的 探讨慢性阻塞性肺疾病 （COPD）患者高分辨率CT （HRCT）肺血管指标与超声心动图肺动脉收缩压 （PASP）的关系以及评估 HRCT肺血管指标的临床意义。方法 门诊入组52例稳定期COPD患者,超声心动图测量PASP,HRCT测量主肺动脉直径 （mPAD）、轴位斜 mPAD、冠状位 mPAD、矢状位 mPAD、右肺动脉直径 （RPAD）、左肺动脉直径 （LPAD）、主动脉直径（AAD）,用ImageJ1 48计算横截面积＆lt;5mm2 血管的总横截面积占肺总面积的百分比 （%CSA＆lt;5）,用GEThoracicVCAR计算低衰减区域 （＆lt;-950HU）百分比 （%LAA）评估肺气肿程度,同时完成肺功能及包括改良版英国医学研究委员会 （mMRC）问卷、COPD评估测试 （CAT）、AECOPD频率等指标的调查问卷。按PASP≤36mmHg、＆gt;36mmHg将患者分为无肺动脉高压 （PH）组和PH组。结果 （1）PH组患者的mPAD、轴位斜mPAD、矢状位mPAD、RPAD、LPAD、mPAD/AAD较无PH组增加。（2）PASP分别与mPAD、轴位斜mPAD、矢状位mPAD、RPAD、LPAD、mPAD/AAD呈正相关 （r =0 567、0 403、0 396、0 495、0 492、0 573）,mMRC 分别与 mPAD、冠状位mPAD呈正相关,CAT分别与 mPAD、轴位斜 mPAD、冠状位 mPAD、RPAD、mPAD/AAD呈正相关,AECOPD频率分别与 mPAD、轴位斜 mPAD、RPAD、mPAD/AAD呈正相关。（3）多因素线性回归分析,PASP分别与 mPAD、轴位斜 mPAD、矢状位 mPAD、RPAD、LPAD、mPAD/AAD存在线性关系。（4）RPAD诊断PH的ROC曲线下面积最大,阈值为22 0mm时,敏感性为84 6%,特异性为68 4%。以上P 值均＆lt;0 05。结论 COPD患者 HRCT肺动脉直径与PASP、临床症状评分、AECOPD频率相关性良好。mPAD、矢状位 mPAD、RPAD、LPAD、mPAD/AAD等指标对诊断PH有提示意义,为COPD患者的病情评估提供了新的依据。Objective To explore the relationship between high resolution CT （HRCT） measurement ofpulmonary vascular indexes and echocardiography measurement of pulmonary arterial systolic pressure （PASP） and evaluate the clinical significance of pulmonary vascular indexes. Methods Fifty-two stable chronic obstructive pulmonary disease （COPD） patients were recruited in the study. Measure PASP with echocardiography. The pulmonary vascular indexes of CT were measured includingthe main pulmonary artery diameter （mPAD）, axial diagonal mPAD, coronal mPAD, sagittal mPAD, right pulmonary arterydiameter （RPAD）, left pulmonary artery diameter （LPAD） and ascending aortic diameter （AAD）. The% CSA% 5 （percentage of total cross-sectional area of the vascular with cross-sectional area less than 5 mm^2 to total area of the lung） wascalculated with Image J 1.48. The %LAA Epercentage of low attenuation areas （〈-950 HU）] representing degree of emphysema was calculated with GE Thoracic VCAR. Lung function test and questionnaires including mMRC, CAT and frequency of AECOPD were completed. According to PASP≤36 mmHg or ）36 mmHg, patients were separated to group with no PH and group with PH. Results （1） Compared to patients with no-PH, mPAD, axial diagonal mPAD, sagittal mPAD, RPAD, LPAD and mPAD/AAD in patients with PH were higher. （2） PASP was positively correlated with mPAD, axial diagonal mPAD, sagittal mPAD, RPAD, LPAD and mPAD/AAD（ r = 0.567, 0.403, 0.396, 0. 495, 0.492, 0.573） respectively, mMRC was positively correlated with mPAD andcoronalmPAD respectively. CAT was positively correlated with mPAD, axial diagonal, coronalmPAD, RPAD and mPAD/AAD respectively. Frequency of AECOPD was positively correlated with mPAD, axial diagonal mPAD, RPAD and mPAD/AAD respectively. （3）The multivariate linear regression analysis revealed a linear relationship of PASP with mPAD, axial diagonal mPAD, sagittal mPAD, RPAD, LPADand mPAD/AAD respectively. （4）RPAD was used to diagnose PH with the bigge

关 键 词：慢性阻塞性肺疾病 血管重塑 肺动脉高压 多层螺旋CT 

分 类 号：R544.1[医药卫生—心血管疾病]