CTPA技术及血清学指标在不同类型急性肺栓塞鉴别中的应用  

Application of CTPA technique and serological indicators in differential diagnosis of different types of acute pulmonary embolism

作　　者：王晶[1] 邵海波[2] 肖文秀[3] 李淑芳[4] 陆泳[5] WANG Jing;SHAO Haibo;XIAO Wenxiu;LI Shufang;LU Yong(ICU,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院ICU,上海201203 [2]上海中医药大学附属曙光医院泌尿外科,上海201203 [3]上海中医药大学附属曙光医院监护室,上海201203 [4]上海中医药大学附属曙光医院感染科兼监护室,上海200021 [5]上海中医药大学附属曙光医院血液科,上海200021

出　　处：《中国急救复苏与灾害医学杂志》2022年第12期1609-1613,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海市科学技术委员会科研计划项目(编号:19401933200)。

摘　　要：目的探讨CT肺动脉成像(CTPA)技术及血清学指标在不同类型急性肺栓塞(APE)鉴别中的应用价值。方法回顾性分析2021年1月—2022年1月上海中医药大学附属曙光医院收治的108例APE患者的临床资料,所有患者依据栓塞位置不同分为中央型(n=46)与周围型(n=62)。所有患者入院后均行CTPA及D-二聚体(D-D)、脑利钠肽(BNP)、心肌肌钙蛋白I(cTnI)、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))检测。比较中央型与周围型APE患者基线资料信息[性别、年龄、身体质量指数(BMI)、吸烟史、饮酒史、住院时间、创伤或手术史、是否合并慢性肺病、是否合并肺部感染、临床症状(呼吸困难、胸痛、咳嗽或咳痰、下肢肿痛、咯血、晕厥)]及CTPA(心包积液、肺梗死、肺不张、右心增大、腹腔积液、肺动脉干增粗、肺纹理稀疏、马赛克征)、实验室指标(D-D、BNP、cTnI、PaO_(2)、PaCO_(2))差异。通过ROC分析cTnI预测中央型APE的价值。最后将中央型及周围型APE患者有差异信息纳入多因素Logistic回归分析,明确中央型APE发生的影响因素。结果不同类型APE患者性别、年龄、BMI、吸烟史、饮酒史、住院时间、创伤或手术史、合并慢性肺病、合并肺部感染、临床症状及心包积液、肺不张、腹腔积液、肺纹理稀疏及D-D、BNP、PaO_(2)、PaCO_(2)水平比较差异无统计学意义(P>0.05);中央型APE患者肺梗死、右心增大、肺动脉干增粗、马赛克征占比显著高于周围型APE患者,血清cTnI水平显著高于周围型APE患者,差异有统计学意义(P<0.05)。经ROC分析证实cTnI≥0.275μg/L时可用于中央型APE的预测,曲线下面积为0.877,标准误为0.036,95%可信区间为0.807~0.947,敏感度为0.848,特异性为0.855,且P<0.05。经多因素Logistic回归分析证实肺梗死、右心增大、肺动脉干增粗、马赛克征及cTnI水平是中央型APE发生的显著影响因素(P<0.05)。经一致性分析证Objective To investigate the application values of CT pulmonary artery imaging(CTPA)and serological indexes in the differentiation of different types of acute pulmonary embolism(APE).Methods The clinical data of 108 APE patients admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2021 to January 2022 were retrospectively analyzed.All patients were divided into central type(n=46)and peripheral type(n=62)according to embolic location.Relevant clinical data were collected.Peripheral fasting venous blood samples were collected to test the level of D-dimer(D-D)by ELISA,and the levels of brain natriuretic peptide(BNP)and cardiac troponin I(cTnI)by chemiluminescence immunoassay.Full automatic blood gas analyzer was used to test the arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2)).The baseline information,laboratory indicators,and CTPA signswere analyzed by multivariate logistic regression.The value of cTnI in predicting central APE was analyzed by ROC.Results There were no significant differences in gender,age,BMI,smoking history,drinking history,length of hospital stay,trauma or surgical history,complicity of chronic lung disease,complicity of lung infection,clinical symptoms,pericardial effusion,atelectasis,abdominal effusion,lung texture spariness and levels of d-D,BNP,PaO_(2)and PaCO_(2)among different APE patients(all P>0.05).The proportions of pulmonary infarction,enlargement of right heart,thickening of pulmonary trunk and mosaic sign in the patients with central APE were all significantly higher than in the patients with peripheral APE,and the level of serum cTnI in the patients with central APE was significantly higher than that in the patients with peripheral APE(all P<0.05).Multivariate logistic regression analysis confirmed that pulmonary infarction,enlargement of right heart,thickening of pulmonary trunk,mosaic sign and cTnI level were the significant influencing factors for the occurrence of centra

关 键 词：急性肺栓塞 栓塞部位 中央型 周围型 CT肺动脉成像 

分 类 号：R563.5[医药卫生—呼吸系统]