CT心功能参数结合生化指标及Wells评分在急性肺动脉栓塞30 d不良预后中的评估价值  

Evaluation value of CT-based cardiac function parameters combined with biochemical indicators and Wells’score in 30-day poor prognosis of acute pulmonary embolism

作　　者：胡杰[1] 刘晓伟[2] 刘亚珍 刘晓蕾 周莹[1] 常俊茹 HU Jie;LIU Xiaowei;LIU Yazhen(Imaging Center,the Third Hospital of Shijiazhuang,Hebei,Shijiazhuang 050000,China;不详)

机构地区：[1]河北省石家庄市第三医院影像中心,050000 [2]河北医科大学第二医院放射科

出　　处：《河北医药》2024年第13期1940-1945,共6页Hebei Medical Journal

摘　　要：目的 探讨256层螺旋CT心功能相关参数、实验室指标及Wells评分对急性肺栓塞(acute pulmonary embolism, APE)严重程度的诊断效能,观察联合应用对提高急性肺栓塞患者30 d不良预后的预测价值。方法 纳入2018年5月至2021年11月行肺CT血管造影(CTPA)检查确诊为急性肺动脉栓塞住院患者进行回顾性分析,随访30 d且资料齐全者共225例,对照组为同期接受CTPA检查并确诊无肺栓塞患者70例。收集患者临床资料和实验室指标[肌酸激酶(CK)、肌酸激酶-特异性同工酶(CK-MB)和D-二聚体],计算Wells评分。采用心功能软件定量测量右心室(RV)、左心室(LV)体积;分别在横轴位图像、重建四腔心层面上测量右、左心室短径及截面积,计算其比值。对2组患者的上述定量指标进行分析。结果 2组患者肺部感染、冠心病史、既往肺栓塞或深静脉血栓病史、癌症活动期、手术/制动史及心率≥100次/min比较差异有统计学意义(P<0.05)。RVD/LVD-ax、RVA/LVA-ax、RVD/LVD-4ch、RVA/LVA-4ch、RVV/LVV、D-二聚体及Wells评分在对照组、急性肺栓塞预后良好与预后不良间差异有统计学意义(P<0.05)。RVD/LVD-ax在预测30 d不良预后及早期死亡方面AUC值最大,分别为0.692、0.724。RVA/LVA-ax与D-二聚体、Wells评分三者联合检测时在预测早期死亡方面AUC值最大。ROC曲线分析显示冠状窦直径>8.65 mm时急性肺栓塞后右心后负荷增加的风险增大。结论 RVA/LVA-ax与D-二聚体、Wells评分三者联合预测效能最佳;与重建四腔心径线、面积及体积相比,横轴位测量心脏形态改变对评价APE预后更优;当冠状窦直径>8.65 mm时急性肺栓塞后右心后负荷增加的风险增大,可帮助临床进行风险分层。Objective To investigate the diagnostic efficacy of 256-slice spiral computer tomography(CT)-based cardiac function parameters,laboratory testing and Wells’scores in the severity of acute pulmonary embolism(APE),and to further observe the value of combined application in predicting 30-day poor prognosis of APE.Methods A total of 225 inpatients diagnosed with APE by CT pulmonary angiography(CTPA)from May 2018 to November 2021 were retrospectively included in the APE group(n=225).They were followed up for 30 days with available complete data.During the same period,participants without APE examined by CTPA were included in the control group(n=70).Clinical data and laboratory indicators(creatine kinase[CK],creatine kinase MB[CK-MB]and D-dimer)were collected and Wells’scores were calculated.The right(RV)and left ventricular(LV)volumes were quantitatively measured by cardiac function software.The right and left ventricular short diameter and cross-sectional area were measured on the transverse view(ax)and reconstructed 4-chamber view(4ch),and their ratios were calculated.The above quantitative indexes were compared between groups.Results There were significant differences in the pulmonary infection,history of coronary heart disease,history of pulmonary embolism or deep vein thrombosis,active stage of cancer,operation/immobilization history and heart rate≥100 beats/min between the two groups(P<0.05).There were significant differences in the RVD/LVD-ax,RVA/LVVA-AX,RVD/LVD-4ch,RVA/LVVA-4CH,RVV/LVV,D-dimer and Wells’scores between control group and APE group(P<0.05).The area under the curve(AUC)of RVD/LDV-AX was the largest in predicting 30-day poor prognosis(AUC=0.692)and early death(AUC=0.724).The AUC of RVA/LVA-ax combined with D-dimer and Wells’score was the largest in predicting early death.Receiver operating characteristic(ROC)curve analysis showed that the risk of increased right cardiac afterload after APE increased when the coronary sinus diameter was greater than 8.65 mm.Conclusion RVA/LVA-ax combined w

关 键 词：肺栓塞 急性 心功能参数 实验室指标 联合诊断 不良预后 

分 类 号：R563.5[医药卫生—呼吸系统]