多层螺旋CT多参数对急性肺动脉栓塞危险分层的效果评估  

Assessment of the effectiveness of multi-slice spiral CT multiparameter for risk stratification of acute pulmonary embolism

作　　者：朱林 卢冉[3] 郭飞[1,4] ZHU Lin;LU Ran;GUO Fei(Department of Radiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China;不详)

机构地区：[1]蚌埠医学院第一附属医院放射科,安徽蚌埠233004 [2]蚌埠医学院研究生院,安徽蚌埠233004 [3]蚌埠医学院第一附属医院血管外科 [4]蚌埠医学院医学影像学院医学影像诊断教研室,安徽蚌埠233004

出　　处：《中华全科医学》2021年第12期2093-2097,共5页Chinese Journal of General Practice

基　　金：安徽省教育厅重点项目(KJ2019A0327);蚌埠医学院校级重点项目(2020byzd135)。

摘　　要：目的探讨多层螺旋CT(multi-slice spiral CT,MSCT)多参数在急性肺动脉栓塞(acute pulmonary embolism,APE)危险分层中的诊断价值。方法纳入2019年1月—2020年10月期间蚌埠医学院第一附属医院经MSCT确诊为APE的74例患者,根据血流动力学状态、右心室功能及心肌是否损伤将患者分为高危组(18例)、中高危组(26例)及中低危组(30例),比较各组间肺动脉阻塞指数(PAOI)及其他影像学参数、临床及实验室指标的差异,用受试者工作特征曲线评价PAOI及心血管参数对于高危和中高危组患者的预测价值,采用多元有序logistic回归分析高危或中高危组APE患者的独立危险因素。结果不同组患者在乳酸脱氢酶(LDH)、PAOI、肺动脉干最宽处直径(PTD)、PTD/同一层面升主动脉直径(AAD)、右心室短轴直径(RVD)/左心室短轴直径(LVD)和累及肺段动脉方面差异有统计学意义(均P<0.001)。PAOI(>38.8%)评估APE高危和中高危患者的灵敏度和特异度分别为65.9%和80.0%,且PAOI值高是APE患者出现高危或中高危的独立危险因素(P<0.001),RVD/LVD(>1.2)、PTD/AAD(>0.9)评估APE高危及中高危患者的灵敏度和特异度分别为59.1%和93.3%、65.9%和86.7%。结论MSCT多参数可能用来评估APE患者的严重程度及预测病情进展,指导临床治疗。Objective To investigate the diagnostic value of multi-slice spiral CT(MSCT)multiparameter in the risk stratification of acute pulmonary embolism(APE).Methods Seventy-four patients diagnosed with APE by MSCT in the First Affiliated Hospital of Bengbu Medical College between January 2019 and October 2020 were included,and the patients were divided into high-risk group(18 patients),medium-high risk group(26 patients)and medium-low risk group(30 patients)according to hemodynamic status,right ventricular function and whether the myocardium was damaged,and the differences in PAOI and other imaging parameters.Clinical and laboratory indices between the groups were compared,and the subject workup characteristic curves were used to evaluate the predictive value of PAOI and cardiovascular.The predictive value of PAOI and cardiovascular parameters for patients in the high-risk and medium-high risk group was evaluated using subject work characteristic curves,and independent risk factors for APE patients in the high-risk or medium-high risk group were analyzed using multivariate ordered logistic regression.Results Statistically significant differences were found in LDH,PAOI,PTD,PTD/AAD,RVD/LVD and involvement of pulmonary segmental arteries in different groups of patients(all P<0.001).The sensitivity and specificity of PAOI(>38.8%)for assessing patients at high-risk and medium-high risk of APE were 65.9%and 80.0%,and higher PAOI values are an independent risk factor for patients at high-risk or medium-high risk of APE(P<0.001).The sensitivity and specificity of RVD/LVD(>1.2)and PTD/AAD(>0.9)for assessing patients at high-risk and medium-high risk of APE were 59.1%and 93.3%,65.9%and 86.7%,respectively.Conclusion MSCT multiparameter may be used to assess the severity and predict the progression of APE patients and guide clinical treatment.

关 键 词：多层螺旋CT 急性肺动脉栓塞 危险分层 独立危险因素 

分 类 号：R445.3[医药卫生—影像医学与核医学] R543.2[医药卫生—诊断学]