新型超声量表评估次大面积肺栓塞的可行性研究  

Feasibility of a novel ultrasonic scale for evaluation of sub-massive pulmonary embolism

作　　者：王爽[1] 段新 孙智超 陈双[1] 吴言[1] 吴炳祥[2] 张若溪[2] 田家玮[1] 杜国庆[1] Wang Shuang;Duan Xin;Sun Zhichao;Chen Shuang;Wu Yan;Wu Bingxiang;Zhang Ruoxi;Tian Jiawei;Du Guoqing(Department of Ultrasound,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Cardiology,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院超声医学科,150086 [2]哈尔滨医科大学附属第二医院心内科,150086

出　　处：《中华超声影像学杂志》2020年第6期499-504,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨新型超声量表评估次大面积肺栓塞的应用价值。方法回顾分析2017年9月至2019年6月于哈尔滨医科大学附属第二医院经计算机断层肺血管造影(CTPA)确诊为急性肺栓塞患者137例,选取77例作为实验集,其余60例作为验证集。依据2019年欧洲心脏病学会(ESC)肺栓塞指南分为次大面积肺栓塞组(sub-PE组,71例)和小面积肺栓塞组(small-PE组,66例)。应用统计学方法在实验集中筛选出有意义的超声参数制成超声量表,再运用量表对验证集患者进行评分,绘制ROC曲线,评估新量表对sub-PE的诊断效能。结果①一般情况:sub-PE组较small-PE组年龄稍大[(61.57±1.45)岁对(56.31±1.59)岁,P=0.016],其余一般资料数据两组间差异无统计学意义(均P>0.05)。②实验集:77例肺栓塞患者中sub-PE组41例与small-PE组36例。与small-PE组相比,sub-PE组右室前后径、肺动脉主干内径、右室/左室比值、三尖瓣反流速度、Tei指数、下腔静脉内径明显增大(均P<0.05),而右室前壁运动幅度、右房面积变化率、右室面积变化率、三尖瓣环收缩期位移、下腔静脉塌陷率以及肺动脉血流加速时间明显减小(均P<0.05);通过实验集筛选出15项超声参数制成超声量表。③验证集由每组各30例组成,sub-PE组较small-PE组分值显著增加(11.63±3.87对4.43±1.96,P<0.001);应用新型超声量表诊断sub-PE的ROC曲线下面积为0.96,以6.5为截断值时敏感性为90.00%,特异性为83.33%。结论新型超声量表为临床评价sub-PE提供一种综合可行的超声影像学方法。Objective To explore the application value of a novel ultrasonic scale in the evaluation of sub-massive pulmonary embolism(sub-PE).Methods Retrospective analyses were conducted in 137 patients with acute pulmonary embolism confirmed by computed tomography pulmonary angiography(CTPA)in the second affiliated hospital of Harbin Medical University from September 2017 to June 2019.They were divided into experimental set(77 cases)and testing set(60 cases).According to the European Society of Cardiology(ESC)guidelines for pulmonary embolism in 2019,the patients were classified into sub-PE(71 cases)and small pulmonary embolism(small-PE,66 cases).Parameters in the experimental set were screened by statistical methods to make an ultrasonic scale,and then the patients in the testing set were scored by the scale.ROC curve was plotted to calculate the diagnostic efficacy of the ultrasonic scale for sub-PE.Results①The patients of sub-PE were older than small-PE patients[(61.57±1.45)years vs(56.31±1.59)years,P=0.016],but there was no significant difference between the two groups in other general data(P>0.05).②Within the 77 pulmonary embolism patients in the experimental set,41(53.25%)were classified as the sub-PE and 36(46.75%)as the small-PE.Compared with the small-PE group,right ventricular diameter,pulmonary artery trunk diameter,right ventricle/left ventricle ratio,tricuspid regurgitation velocity,the Tei index and the inferior vena cava diameter in the sub-PE group increased significantly(P<0.05),and right ventricular wall motion amplitude,right atrium area rate,right ventricular area rate,tricuspid annulus systolic displacement,collapse rate of inferior vena cava and pulmonary artery blood flow acceleration time decreased significantly(P<0.05);③Fifteen ultrasonic parameters were used in the ultrasonic scale.The scale in sub-PE group of the testing set was significantly increased compared with that in small-PE group(11.63±3.87 vs 4.43±1.96,P<0.001).ROC showed that the AUC in diagnosing sub-PE by ultrasonic scale

关 键 词：超声量表 次大面积肺栓塞 急性 右心功能 

分 类 号：R563.5[医药卫生—呼吸系统] R445.1[医药卫生—内科学]