胸部CT对慢性阻塞性肺疾病合并肺动脉高压的分级诊断价值  

Clinical value of chest CT in grading diagnosis on pulmonary hypertension complicated with chronic obstructive pulmonary disease

作　　者：贾铁钢 乜庆荣 邓赶飞 谢宝元 JIA Tiegang;NIE Qingrong;DENG Ganfei;XIE Baoyuan(Department of Respiratory and Critical Care Medicine,Liangxiang Hospital of Fangshan District,Beijing 102401,China)

机构地区：[1]房山区良乡医院呼吸与危重症医学科,北京102401

出　　处：《贵州医科大学学报》2022年第2期224-228,共5页Journal of Guizhou Medical University

基　　金：国家重点研发计划(2016YFC1304405);北京市科技计划课题(D151100002115004)。

摘　　要：目的探讨胸部CT对慢性阻塞性肺疾病(COPD)合并肺动脉高压(PAH)的分级诊断价值。方法选取153例COPD患者作为研究对象,分别采用胸部CT测量升主动脉(AD)和主肺动脉干(MPAD)直径、计算MPAD/AD比值,定义MPAD/AD>1为肺动脉高压,将MPAD/AD比值1~1.3、1.3~1.5和>1.5界定为轻、中、重度PAH;采用心脏多普勒超声测定肺动脉收缩压(PASP),PASP≥30 mmHg为肺动脉高压;以右心导管术(RHC)检查结果为金标准,比较胸部CT和心脏多普勒超声诊断COPD合并PAH准确性;采用受试者工作(ROC)曲线下面积(AUC)评估胸部CT获得的MPAD/AD对COPD合并PAH的诊断价值,采用logistic回归分析MPAD/AD、PASP与COPD合并PAH的相关性。结果COPD合并PAH,RHC检出51例(33.3%),与RHC比较,胸部CT检出47例(30.7%)、准确率92.2%,心脏多普勒超声检出48例(31.4%)、准确率为94.1%,后2种方法的检出准确率比较,差异无统计学意义(P>0.05);RHC检查示轻度、中度和重度PAH分别有16例(31.4%)、18例(35.3%)和17例(33.3%),胸部CT对于PAH分级诊断的准确率为75.0%、88.9%和100%,多普勒超声为81.3%、94.4%和100%,两者比较差异无统计学意义(P>0.05),kappa系数为0.845(P<0.001);ROC曲线分析显示,MPAD、AD和MPAD/AD对于COPD合并PAH均有较好诊断价值(AUC>0.5),其中以MPAD/AD的AUC较高(AUC为0.814、95%CI为0.735~0.889),敏感性和特异性分别为68.7%和80.1%;logistic回归分析显示,MPAD/AD和PASP值均是COPD合并PAH发生的独立性影响因素(OR=1.857、1.977)。结论胸部CT对COPD患者合并PAH的分级诊断具有较好临床应用价值。Objective To investigate the clinical value of chest CT in grading diagnosis of chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PAH).Methods 153 patients with COPD were chosen as research subjects.Chest CT was adopted to measure ascending aorta diameter(AD)and main pulmonary artery trunk(MPAD),and calculate MPAD/AD ratio.MPAD/AD>1 was defined as pulmonary hypertension.MPAD/AD ratio for further classification of mild,moderate,and severe PAH were 1-1.3,1.3-1.5,and>1.5.Pulmonary arterial systolic pressure(PASP)was detected by cardiac Doppler ultrasound.PASP≥30 mmHg was pulmonary hypertension.The diagnostic accuracy of chest CT and cardiac Doppler ultrasound to diagnose COPD complicated with PAH was compared against the results of RHC(the gold standard).The diagnostic value of chest CT index MPAD/AD was analyzed by ROC curve AUC.Correlation between MPAD/AD,PASP,and COPD complicated with PAH was analyzed by logistic regression.Results RHC detected 51 cases of COPD patients with PAH(33.3%),and 47 cases(30.7%)by chest CT scan.The accuracy rate was 92.2%of the latter.The detection rate of cardiac Doppler ultrasound was 31.4%(48 cases),with the accuracy rate of 94.1%.There was no significant differences in the accuracy rate of chest CT and Doppler ultrasound(P>0.05).RHC detected PAH cases of mild,moderate,and severe condition in 16 cases(31.4%),18 cases(35.3%),and 17 cases(33.3%),respectively.The accuracy rate of chest CT for PAH grading diagnosis was 75.0%,88.9%,and 100%,and that of Doppler ultrasound was 81.3%,94.4%,and 100%,respectively.There was no statistical significance between the differences(P>0.05);kappa coefficient was 0.845(P<0.001).ROC curve analysis showed that MPAD,AD,and MPAD/AD yielded better diagnostic value for COPD complicated with PAH(AUC>0.5);the AUC area of MPAD/AD was higher(AUC was 0.814,95%CI was 0.735-0.889),with sensitivity and specificity of 68.7%and 80.1%.Logistic regression analysis showed that MPAD/AD and PASP values were independent influencing factors

关 键 词：胸部CT 右心导管术 慢性阻塞性肺疾病 多普勒超声 肺动脉高压 诊断 

分 类 号：R445[医药卫生—影像医学与核医学]