慢性血栓栓塞性肺疾病与慢性血栓栓塞性肺动脉高压肺血管分形维数和弯曲度对比研究  

Comparison of pulmonary vascular tortuosity and fractal dimension in patients with chronic thromboembolic pulmonary disease and chronic thromboembolic pulmonary hypertension

作　　者：孟夏培 孙学彪 许文清 陶新曹[2] 谢万木[2] 刘敏[3] Meng Xiapei;Sun Xuebiao;Xu Wenqing;Tao Xincao;Xie Wanmu;Liu Min(Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,National Respiratory Disease Center,China-Japan Friendship Hospital,Beijing 100029,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京大学中日友好临床医学院,北京100029 [2]中日友好医院呼吸与危重症科,国家呼吸病中心,北京100029 [3]中日友好医院放射诊断科,北京100029

出　　处：《中华结核和呼吸杂志》2023年第8期774-780,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金(82272081);中国医学科学院医学与健康科技创新工程(2022-I2M-C&T-B-109);高水平医院临床业务费专项(2022-NHLHCRF-LX-01);中日友好医院“菁英计划”人才培育工程资助(ZRJY2021-BJ02)

摘　　要：目的比较慢性血栓栓塞性肺疾病(CTEPD)及慢性血栓栓塞性肺动脉高压(CTEPH)患者的CT肺血管造影(CTPA)中肺血管形态学参数差异,探讨肺血管形态学在CTEPD与CTEPH鉴别诊断中的价值。方法回顾性纳入2018年1月至2020年12月中日友好医院CTEPH患者39例,其中男14例,女25例,年龄(54.1±12.4)岁;CTEPD患者29例,其中男10例,女19例,年龄(51.4±18.0)岁。基于CTPA图像提取肺血管,计算肺血管的形态学参数,包括肺动脉及肺静脉分支数量、肺动脉及静脉弯曲度、肺动脉及静脉分形维数。比较两组间肺动脉形态参数之间差异,并分析形态学参数与右心漂浮导管测定血流动力学参数的相关性。结果CTEPH组肺动脉分支数量为(249.43±76.27)支,较CTEPD组明显少[(298.79±78.11)支,t=2.612,P=0.011];CTEPH组肺动脉弯曲度为(1.26±0.17),明显高于CTEPD组(1.17±0.10,t=3.516,P=0.002)。两组间肺动脉分形维数(3.01±0.21比3.08±0.22)差异无统计学意义(t=1.359,P=0.179)。肺动脉分支数量与肺血管阻力负相关(r=-0.325,P=0.026),肺动脉弯曲度与平均肺动脉压正相关(r=0.387,P=0.017),与肺血管阻力正相关(r=0.647,P<0.001)。结论肺动脉形态学参数肺动脉弯曲度,是鉴别CTEPH与CTEPD的重要形态学参数,与平均肺动脉压及肺血管阻力相关。ObjectiveTo compare the differences in pulmonary vascular morphological parameters between patients with chronic thromboembolic pulmonary disease(CTEPD)and chronic thromboembolic pulmonary hypertension(CTEPH),and to explore the value of pulmonary artery morphology in the differential diagnosis of CTEPD and CTEPH.MethodsThirty-nine patients with CTEPH[14 males,25 females,mean age:(54.1±12.4)years]and 29 patients with CTEPD[10 males,19 females,mean age:(51.4±18.0)years]from January 2018 to December 2020 were retrospectively included.The pulmonary artery and vein tree was segmented from the computed tomography pulmonary angiography(CTPA)images,and the morphological parameters of pulmonary vessels including the number of pulmonary arteries,pulmonary arterial tortuosity(distance metric,DM)and fractal dimension(FD),were calculated.The differences in pulmonary vascular morphological parameters between the two groups were compared,and the correlation between morphological parameters and hemodynamics was analyzed.ResultsThere was no significant difference in gender and age between CTEPH and CTEPD groups(χ^(2)=0.015,P=0.904&t=-0.729,P=0.469).The number of pulmonary arteries in CTEPH group(n=249.43±76.27)was significantly lower than that in CTEPF group(n=298.79±78.11,t=2.612,P=0.011).The pulmonary arterial tortuosity in CTEPH group(DM=1.26±0.17)was significantly higher than that in CTEPD group(DM=1.17±0.10,t=3.516,P=0.002).There was no significant difference in FD between CTEPH and CTEPD(FD=3.01±0.21&3.08±0.22,t=1.359,P=0.179).The number of pulmonary arteries was negatively correlated with pulmonary vascular resistance(r=-0.325,P=0.026).Pulmonary arterial tortuosity was positively correlated with mean pulmonary artery pressure(r=0.387,P=0.017),and was positively correlated with pulmonary vascular resistance(r=0.647,P<0.001).ConclusionPulmonary artery curvature is an important morphological parameter in differentiating CTEPH from CTEPD,and is related to mean pulmonary artery pressure and pulmonary vascular resistanc

关 键 词：肺动脉栓塞 慢性肺动脉血栓栓塞疾病 慢性血栓栓塞性肺动脉高压 CT肺血管造影 肺动脉弯曲度 分形维数 

分 类 号：R563[医药卫生—呼吸系统] R544.1[医药卫生—内科学]