CT肺动脉造影结合血清学标志物在急性肺栓塞诊断中的应用  

Application of CT Pulmonary Angiography Combined with Serological Markers in the Diagnosis of Acute Pulmonary Embolism

作　　者：潘婷 夏蕾 石容容 邵海磊 徐秋贞[1] PAN Ting;XIA Lei;SHI Rong-rong;SHAO Hai-lei;XU Qiu-zhen(Department of Radiology,Jiangbei District,Zhongda Hospital,Southeast University,Jiangsu 211500,Nanjing Province,China)

机构地区：[1]东南大学附属中大医院江北院区放射科,江苏南京211500

出　　处：《中国CT和MRI杂志》2023年第4期67-69,共3页Chinese Journal of CT and MRI

基　　金：江苏省医学会科研专项资金项目合同书(SYH-3201150-0009(2021004));江苏省医学会伦琴影像科研专项资金项目。

摘　　要：目的探讨CT肺动脉造影(CTPA)结合血清D-二聚体(D-Dimer)、脑钠肽(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平在急性肺栓塞(APE)诊断中的应用价值。方法选取本院2018年4月~2021年4月期间收治的130例疑似APE并行CTPA检查患者,以CTPA图像为诊断标准将其分为APE组(n=53)与无APE组(n=77)。所有患者CTPA检查后进行图像重建并分析结果,记录CTPA诊断APE的结果及图像质量评分结果;记录APE患者CTPA征象;比较APE组与无APE组血清D-Dimer、BNP及cTnⅠ水平;ROC曲线分析血清D-Dimer、BNP及cTnⅠ诊断APE的价值。结果130例患者经CTPA确诊APE 53例(40.77%),CTPA图像质量评分4分及以上34例(64.16%);53例确诊患者中共691支肺动脉受累,其中栓塞部位以叶肺动脉栓塞最多,占比39.42%,栓塞类型中以偏心型86(56.21%)为主;APE组血清D-Dimer、BNP及cTnⅠ水平均明显高于无APE组,组间差异显著(P<0.05);ROC曲线分析结果显示,血清D-Dimer、BNP、cTnⅠ诊断APE的AUC分别为0.722、0.781和0.776,联合检测的AUC为0.881(P<0.05)。结论血清D-Dimer、BNP及cTnⅠ对APE具有较高的诊断价值,结合CTPA可以清晰显示栓塞部位及类型。Objective To explore the application value of CT pulmonary angiography(CTPA)combined with serum D-dimer(D-Dimer),brain natriuretic peptide(BNP)and cardiac troponinⅠ(cTnⅠ)in the diagnosis of acute pulmonary embolism(APE).Methods A total of 130 patients with suspected APE undergoing CTPA in the hospital were enrolled between April 2018 and April 2021.Based on CTPA images,they were divided into APE group(n=53)and non-APE group(n=77).After CTPA,all underwent images reconstruction and the results were analyzed.The results of CTPA in the diagnosis of APE,scores of image quality,and CTPA signs in APE patients were recorded.The levels of serum D-Dimer,BNP and cTnI between APE group and non-APE group were compared.And their diagnostic value in APE was analyzed by ROC curves.Results In the 130 patients,there were 53 cases(40.77%)confirmed with APE by CTPA,and 34 cases(64.16%)with score of CTPA image quality not lower than 4 points.Among the 53 confirmed cases,there were 691 branches with pulmonary artery involvement.The main embolism site was pulmonary artery(39.42%),and the main embolism type was eccentric type[86(56.21%)].The levels of serum D-Dimer,BNP and cTnⅠin APE group were significantly higher than those in the non-APE group(P<0.05).The results of ROC curve analysis showed that AUC values of serum D-Dimer,BNP,cTnI and their combination in the diagnosis of APE were 0.722,0.781,0.776 and 0.881,respectively(P<0.05).Conclusion Serum D-Dimer,BNP and cTnI are of high diagnostic value in APE,their combination with CTPA can clearly display the sites and types of embolism.

关 键 词：急性肺栓塞 CT肺动脉造影 血清标志物 诊断 

分 类 号：R445.3[医药卫生—影像医学与核医学]