经胸及经食管超声心动图右心声学造影诊断肺动静脉畸形的临床价值  

Clinical value of contrast transthoracic echocardiography and contrast transesophageal echocardiography in diagnosing pulmonary arteriovenous malformation

作　　者：薛媛[1] 蔡垚 郝美芳[2] 李奕莹[2] 张静璇 徐琨[2] XUE Yuan;CAI Yao;HAO Meifang;LI Yiying;ZHANG Jingxuan;XU Ku(School of Medical Imaging,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学医学影像学院,太原市030001 [2]山西医科大学第一医院超声科

出　　处：《临床超声医学杂志》2024年第4期340-344,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨经胸超声心动图右心声学造影(cTTE)、经食管超声心动图右心声学造影(cTEE)诊断肺动静脉畸形(PAVM)的临床价值。方法选取我院收治的可疑PAVM患者50例,均行cTTE、cTEE观察左心腔内微泡出现时间及微泡数量,并进行半定量分级。绘制受试者工作特征(ROC)曲线分析cTTE、cTEE对PAVM的诊断效能;采用Logistic回归分析cTTE、cTEE半定量分级与PAVM发生的关系。结果50例可疑PAVM患者经胸部CT或CT肺血管造影检查确诊PAVM阳性6例(PAVM组),PAVM阴性44例(非PAVM组)。PAVM组cTTE半定量分级、cTEE半定量分级均高于非PAVM组,差异均有统计学意义(均P<0.05)。纳入患者的cTEE半定量分级高于cTTE,差异有统计学意义(P<0.05)。ROC曲线分析显示,cTTE诊断PAVM的灵敏度、特异度、曲线下面积(AUC)分别为66.7%、86.4%、0.814;cTEE诊断PAVM的灵敏度、特异度、AUC分别为83.3%、88.6%、0.890。Logistic回归分析显示,cTTE、cTEE半定量分级均与PAVM发生相关(均P<0.05),其中cTTE半定量分级>Ⅱ级患者发生PAVM的风险是≤Ⅱ级患者的12.865倍;cTEE半定量分级>Ⅱ级患者发生PAVM的风险是≤Ⅱ级患者的39.450倍。结论对于可疑PAVM患者,应用cTTE、cTEE均可进行早期筛查,且cTEE半定量分级的诊断效能优于cTTE。Objective To explore the clinical value of contrast transthoracic echocardiography(cTTE)and contrast transesophageal echocardiography(cTEE)in the diagnosis of pulmonary arteriovenous malformation(PAVM).Methods Fifty suspected PAVM patients in our hospital were selected.All patients underwent cTTE and cTEE examinations to observe the appearance time and quantity of microbubbles in the left heart cavity,and semi-quantitative grading was performed.Receiver operating characteristic(ROC)curve analysis was performed to compare the diagnostic efficacy of cTTE and cTEE for PAVM.Logistic regression analysis was used to analyze the relationship between semi-quantitative grading by cTTE and cTEE and the occurrence of PAVM.Results Among the 50 suspected PAVM patients,6 positive cases were confirmed for PAVM by chest CT/CTPA pulmonary angiography(PAVM group),and 44 negative cases were confirmed for PAVM(non-PAVM group).The cTTE semi-quantitative grading and cTEE semi-quantitative grading in PAVM group were higher than those in non-PAVM group,and the differences were statistically significant(both P<0.05).The semi-quantitative grading of cTEE in enrolled patient was significantly higher than that of cTTE,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the sensitivity,specificity and area under the curve(AUC)of cTTE in diagnosing PAVM were 66.7%,86.4%and 0.814,respectively,while those of cTEE were 83.3%,88.6%and 0.890,respectively.Logistic regression analysis showed that both cTTE and cTEE semi-quantitative grading were associated with the risk of PAVM(both P<0.05).The risk of PAVM was 12.865 times higher in patients with cTTE semi-quantitative grading>Ⅱthan in patients with cTTE semi-quantitative grading≤Ⅱ.The risk of PAVM was 39.450 times higher in patients with cTEE semi-quantitative grading>Ⅱthan in patients with cTEE semi-quantitative grading≤Ⅱ.Conclusion For suspected PAVM patients,cTTE and cTEE can serve as early screening tests,and the cTEE semi-quantitative grading is

关 键 词：超声心动描记术 经胸 经食管 右心声学造影 肺动静脉畸形 

分 类 号：R540.45[医药卫生—心血管疾病] R543.2[医药卫生—内科学]