CT肺小血管定量参数评估不同类型肺动脉高压的应用研究  

Application study of quantitative parameters of small pulmonary vessels on CT in evaluating different types of pulmonary hypertension

作　　者：徐承啸 张月 张宁[3] 祝因苏[1] 鲁珊珊[1] XU Chengxiao;ZHANG Yue;ZHANG Ning;ZHU Yinsu;LU Shanshan(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China;Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China;Department of Rheumatology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]南京医科大学第一附属医院心血管内科,江苏南京210029 [3]南京医科大学第一附属医院风湿科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第6期832-837,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82171907)。

摘　　要：目的:探讨基于胸部CT测量的肺小血管参数在评估肺动脉高压(pulmonary hypertension,PH)分型及结缔组织疾病相关肺高压(connective tissue diseases-related pulmonary hypertension,CTD-PH)严重程度分级中的临床价值。方法:回顾性纳入170例PH患者,包括60例CTD-PH患者、52例特发性PH(idiopathic pumonary hypertension,IPAH)患者和58例慢性阻塞性肺疾病相关PH(chronic obstructive pulmonary disease-rebated pulmonary hypertension,COPD-PH)患者,同时纳入120例健康受试者(health control,HC)作为对照。基于胸部CT测量横截面面积(cross-sectional area,CSA)<5 mm^(2)的肺小血管CSA之和及CSA 5~10 mm^(2)的肺小血管CSA之和与肺总CSA的比率(%CSA_(<5)和%CSA_(5-10)),采用单因素方差分析或Kruskal-Wallis检验比较4组之间%CSA_(<5)和%CSA_(5-10)的差异,并进行组间两两比较。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析%CSA区分重度CTD-PH(CTD-S-PH组)和中重度CTD-PH(CTD-LM-PH组)的能力,计算曲线下面积(area under curve,AUC)、灵敏度及特异度。结果:与HC组比较,IPAH组和COPD-PH组的%CSA_(<5)均小于HC组(P均<0.001),COPD-PH组的%CSA_(5-10)低于HC组(P=0.038),而CTD-PH和IPAH组的%CSA_(5-10)均显著高于HC组(P均<0.05)。不同类型PH组间比较,CTD-PH的%CSA<5和%CSA_(5-10)均高于COPD-PH组(P均<0.001),IPAH组的%CSA_(5-10)显著高于CTD-PH组(P=0.022),而IPAH和COPD-PH组的%CSA_(<5)差异无统计学意义(P=0.833)。CTD-S-PH组患者的%CSA_(<5)显著低于CTD-LM-PH组(P=0.004)。ROC曲线分析结果显示,%CSA_(<5)预测CTD-S-PH的最佳截断值为0.804,AUC为0.710(95%CI:0.573~0.847),灵敏度为0.714,特异度为0.320。结论:基于胸部CT定量的肺小血管参数%CSA可以区分不同类型PH。在CTD-PH人群中,%CSA_(<5)可作为评估PH严重程度分级的参考依据。Objective:To investigate the clinical value of small pulmonary vessels parameters measured by chest CT in evaluating the classification of different types of pulmonary hypertension(PH)and the severity grading of connective tissue disease s-related pulmonary hypertension(CTD-PH).Methods:A retrospective analysis included 170 PH patients,including 60 CTD-PH patients,52 idiopathic PH(IPAH)patients,and 58 chronic obstructive pulmonary disease-related PH(COPD-PH)patients,with 120 healthy controls(HC)included as controls.The ratio of the sum of the cross-sectional area(CSA)of small pulmonary vessels with CSA<5 mm2(%CSA_(<5))and between 5 to 10 mm^(2)(%CSA_(5-10))to the total CSA of the lung measured by chest CT was compared among the four groups using one-way ANOVA or Kruskal-Wallis test,followed by pairwise comparisons.Receiver operating characteristic(ROC)curve analysis was used to evaluate the performance of%CSA for differentiating mild to moderate CTD-PH(CTD-LM-PH)from severe CTD-PH(CTD-S-PH)patients,and calculate the area under the curve(AUC),sensitivity and specificity.Results:The%CSA_(<5) of the IPAH and COPD-PH groups were significantly lower compared to the HC group(P<0.001).Additionally,the%CSA_(5-10) of the COPD-PH group showed a significant decline compared to the HC group(P=0.038),whereas the%CSA_(5-10) of the CTD-PH and IPAH groups was significantly high compared to the HC group(both P<0.05).In comparisons between different types of PH groups,the%CSA_(<5) and%CSA_(5-10) of the CTD-PH group were higher than those of the COPD-PH group(P<0.001).The%CSA_(5-10) of the IPAH group was significantly higher than that of the CTD-PH group(P=0.022),while there was no significant difference in the%CSA_(<5) between the IPAH and COPD-PH groups(P=0.833).The%CSA_(<5) of CTD-S-PH group was significantly lower than that of CTD-LM-PH group(P=0.004).The ROC curve analysis showed that the optimal cutoff value for%CSA_(<5) to predict CTD-S-PH was 0.804,with an AUC of 0.710(95%CI:0.573-0.847),sensitivity of 0.714 and specificity

关 键 词：肺动脉高压 肺小血管 胸部CT 分型 严重程度 

分 类 号：R544.16[医药卫生—心血管疾病]