探讨RVED/LVED在急性肺栓塞诊断中的价值  

Value of RVED/LVED to diagnosis of acute pulmonary embolism

作　　者：于恪 张圆[2] 何玉虎 张敏[1] Yu Ke;Zhang Yuan;He Yuhu;Zhang Min(Department of Respiratory and Critical Care Medicine,Second People's Hospital of Shenzhen City(First Affiliated Hospital of Shenzhen University),Shenzhen 518035,China;不详)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)呼吸与危重症医学科,深圳518035 [2]深圳市第二人民医院(深圳大学第一附属医院)中心实验室,深圳518035 [3]中南大学湘雅二医院心血管内科,长沙410000

出　　处：《中国循证心血管医学杂志》2020年第7期826-830,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：广东省医学科研基金资助项目(A2019417);国家自然科学基金青年项目(81800059)。

摘　　要：目的探讨右心室舒张末期内径(RVED)与左心室舒张末期内径(LVED)的比值(RVED/LVED)对肺栓塞的诊断价值。方法回顾性分析深圳大学第一附属医院于2016年6月至2019年6月疑似肺栓塞并行CT肺动脉造影(CTPA)患者120例,将60例肺栓塞患者纳入肺栓塞组,60例非肺栓塞患者为对照组。根据RVED/LVED由小到大分为3组(Tertile 1组:RVED/LVED<0.48、Tertile 2组:RVED/LVED:0.48~0.55、Tertile 3组:RVED/LVED≥0.56)。对3组肺栓塞发生率进行趋势性检验分析,应用多因素Logistic回归分析建立RVED/LVED预测肺栓塞的回归模型,通过受试者工作特征曲线分析预测模型对肺栓塞的诊断效能。结果肺栓塞组的RVED/LVED高于对照组(0.55±0.08 vs.0.50±0.06,P<0.001)。Tertile1组、Tertile2组、Tertile3组肺栓塞的发生率呈递增趋势(分别为30.8%、51.2%、67.5%,P for trend=0.001)。RVED/LVED为预测肺栓塞的独立影响因素,对比Tertle1组,Tertle2组与Tertle3组发生肺栓塞的风险比分别为3.690~5.216(P均<0.05)和5.673~9.627(P均<0.05),并呈趋势性增加(P for trend<0.05)。RVED/LVED与D-二聚体诊断肺栓塞的曲线下面积(AUC)分别为0.702、0.708,含RVED/LVED肺栓塞诊断模型可增加AUC 0.034(P=0.04)。结论RVED/LVED对肺栓塞的诊断具有一定的临床价值,结合危险因素及临床指标建立模型对肺栓塞的诊断效能更高。Objective To discuss the diagnostic value of the ratio of right ventricular end-diastolic inner diameter(RVED)and left ventricular end-diastolic inner diameter(LVED,RVED/LVED)to acute pulmonary embolism(APE).Methods The patients(n=120)with suspected APE received computed tomographic pulmonary angiography(CTPA)were retrospectively analyzed in the First Affiliated Hospital of Shenzhen University from June 2016 to June 2019.All patients were divided into APE group(with APE)and control group(without APE,each n=60).In addition,the patients were divided,according to RVED/LVED in an ascending order,into Tertile1 group(RVED/LVED<0.48),Tertile2 group(RVED/LVED=0.48~0.55)and Tertile3 group(RVED/LVED≥0.56).The incidence rate of APE was given trend test analysis.The regression model of RVED/LVED for predicting APE was established by applying multi-factor Logistic regression analysis.The diagnostic efficiency of the model for APE was analyzed by using receiver operating characteristic curve(ROC curve).Results RVED/LVED was higher in APE group than that in control group(0.55±0.08 vs.0.50±0.06,P<0.001).The incidence rate of APE showed an ascending trend in Tertile1 group(30.8%),Tertile2 group(51.2%)and Tertile3 group(67.5%,P for trend=0.001).RVED/LVED was an independent influence factor in APE prediction.Compared with Tertle1 group,the risk ratio of APE was 3.690-5.216(all P<0.05)in Tertle2 group and 5.673~9.627 in Tertle3 group(all P<0.05)showed a tendency increase(P for trend<0.05).The area under ROC curve(AUC)of RVED/LVED was 0.702 and AUC of D-dimer was 0.708 in APE diagnosis.The model of APE diagnosis with RVED/LVED increased AUC by 0.034(P=0.04).Conclusion RVED/LVED has some clinical value in APE diagnosis,and the diagnosis efficiency will be higher after established a model combined risk factors with clinical indexes.

关 键 词：肺栓塞 超声心动图 右心室舒张末期内径 左心室舒张末期内径 D-二聚体 

分 类 号：R563.5[医药卫生—呼吸系统]