CT肺小血管分析在慢性阻塞性肺疾病患者合并严重肺动脉高压中的作用  

The role of CT small pulmonary vessels analysis in patients with chronic obstructive pulmonary disease complicated with severe pulmonary hypertension

作　　者：张兆福 李晓冬 王钺 ZHANG Zhaofu;LI Xiaodong;WANG Yue(Department of Radiology gangzhou People's Hospital,Cangzhou,Hebei Province061000)

机构地区：[1]沧州市人民医院医专院区影像科,河北沧州061000

出　　处：《实用放射学杂志》2021年第1期51-54,共4页Journal of Practical Radiology

摘　　要：目的评估CT测量肺小血管是否有助于识别慢性阻塞性肺疾病(COPD)患者合并严重肺动脉高压(PH).方法40例COPD合并PH患者,在稳定期内进行肺功能测试、胸部CT和右心导管插入术(RHC).10例重度PH[平均肺动脉压(mPAP)>35mmHg(1mmHg=0.133kPa)]COCP患者与30例年龄和1秒用力呼气量(FEV1)匹配的轻度PH患者(mPAP<35mmHg)进行比较.通过CT测量<5mm2血管总横截面积百分比(%CSA<5)和5~10mm2血管总横截面积百分比(%CSA5G10)、平均横截血管数(CSN)和支气管壁厚.通过受试者工作特征(ROC)曲线分析与mPAP最相关的CT参数,以预测COPD患者合并严重PH.结果重度PH患者%CSA和CSN值高于轻度PH患者.多元回归分析显示,重度和轻度PH患者mPAP预测因子分别为%CSA<5和壁厚.在COPD患者中,结合%CSA<5、动脉氧分压(PaO2)和壁厚最能预测严重PH.结论CT检测小血管参数结合壁厚和PaO2,可预测COPD患者合并严重PH,可能为选择RHC患者提供一种非侵入性的工具.Objective To evaluate whetherCT can help to recognize severe pulmonary hypertension(PH)by measuring small pulmonaryvessels in chronic obstructive pulmonary disease(COPD)patientsMethodsThe subjects were 40 COPD patients with PH.They underwentpulmonary function tests,unenhanced CT of the chest and right heart catheterisation(RHC)during a period of stability.Among 40 involvedpatients,10o patients with COPD with severe PH[mean pulmonary arterial pressure(mPAP)>35 mmHg]were compared with 30forced expiratory volume in one second(FEV1)-matched and age-matched patients with COPD with mild PH(mPAP<35 mmHg).The percentage of total crosssectional area of vessels less than 5 mm^2 normalised by lung area(%CSA<5)and 5-10 mm^2(%CSA5-10)the mean nmumber of cross-sectioned vessels(CSN)and bronchial wall thickness(WT)were measured on CT examinationand compared between groups.The most relevant CT parameters of mPAP were analyzed by receiver operating characteristic(ROC)curve analysis curve to predict severe PH in COPD patients.Rsults Patients with severe PH had higher%CSA and CSN values thanthose of patients with COPD with mild PH.Using multiple regression analysis,%CSA<5 and WT were the best predictors of mPAPin patients with severe PH and mild PH,respectively.Combining%CSA<5,PaOz and WT were the lest to predict severe PH in patientswith COPD.Conclusion CT measurements of small vessels parameters combined with WT and PaOp are able to predict severe PH incOCP patients,which may offer a non-invasive tool to select patients for RHC.

关 键 词：慢性阻塞性肺疾病 肺动脉高压 计算机体层成像 肺小血管 

分 类 号：R563[医药卫生—呼吸系统] R543.2[医药卫生—内科学]