心脏彩超、Hcy与急性肺栓塞患者PAOI的关联性及预测疗效价值  

Correlation and predictive value of echocardiography,Hcy and PAOI in patients with acute pulmonary embolism

作　　者：薛晓艳 姜华[1] 刘聪敏 XUE Xiaoyan;JIANG Hua;LIU Congmin(Department of Jiaozuo Special Inspection,No.988 Hospital of Joint Logistic Support Force,Jiaozuo 454000,China)

机构地区：[1]中国人民解放军联勤保障部队988医院焦作院区特检科,焦作454000

出　　处：《华夏医学》2024年第4期70-76,共7页Acta Medicinae Sinica

基　　金：河南省医学科技攻关联合共建项目(LHGJ20224171)。

摘　　要：目的探讨心脏彩超、血清同型半胱氨酸(Hcy)水平与急性肺栓塞(APE)患者CT肺栓塞阻塞指数(PAOI)的关联性及预测疗效的价值。方法选取149例APE患者为研究对象,依据PAOI分为轻度(PAOI分值<30%)45例,中度(30%≤PAOI分值<50%)58例,重度(PAOI分值≥50%)46例,分析入院时心血管参数、血清Hcy水平与PAOI的相关性以及对疗效的预测价值。结果入院时重度患者右心房收缩末内径(RAESD)、右心室舒张末内径(RVEDD)、主肺动脉内径(MPA)、肺动脉收缩压(SPAP)参数及Hcy水平高于中度患者和轻度患者,差异有统计学意义(P<0.05);入院时RAESD、RVEDD、MPA、SPAP参数及血清Hcy水平与PAOI均呈正相关(P<0.05);与有效患者相比,治疗1周、2周、3周后,无效患者RAESD、RVEDD、MPA、SPAP参数及Hcy水平更高(P<0.05);ROC曲线显示,治疗1周、2周、3周后,RAESD、RVEDD、MPA、SPAP、Hcy联合预测APE治疗无效的AUC依次为0.877、0.922、0.934(P<0.05)。结论心脏彩超参数、Hcy可反映APE患者病情状况,且联合应用时能预测APE治疗无效的风险,为完善治疗方案起指导作用。Objective To explore the correlation between echocardiography,serum homocysteine(Hcy)levels and CT pulmonary embolism obstruction index(PAOI)in patients with acute pulmonary embolism(APE),as well as its value in predicting therapeutic efficacy.Methods 149 patients with APE were selected for the study,and were classified as mild(PAOI score<30%)45 cases,moderate(30%≤PAOI score<50%)58 cases,and severe(PAOI score≥50%)46 cases,and the correlation of cardiovascular parameters,serum Hcy level and PAOI at admission and their predictive value of the therapeutic efficacy were analyzed.Results At admission,the right atrial end-systolic diameter(RAESD),right ventricular end-diastolic diameter(RVEDD),main pulmonary artery diameter(MPA),systolic pulmonary artery pressure(SPAP),and Hcy levels were higher in severe patients than in moderate patients and mild patients,and the difference was statistieally significant(P<0.05).At admission,RAESD,RVEDD,MPA,SPAP,and serum Hcy levels were positively correlated with PAOI(P<0.05).Compared with effective patients,the RAESD,RVEDD,MPA,SPAP,and Hcy levels were higher in ineffective patients after 1,2,and 3 weeks of treatment(P<0.05).The ROC curve showed that the AUC of RAESD,RVEDD,MPA,SPAP,and Hcy combined to predict ineffective treatment of APE after 1,2 and 3 weeks of treatment were 0.877,0.922 and 0.934,respectively(P<0.05).Conclusion Echocardiography parameters and Hcy reflect the condition of patients with APE,and when combined,they can predict the risk of ineffective APE treatment,providing guidance for improving treatment plans.

关 键 词：急性肺栓塞 心脏彩超 血清同型半胱氨酸 肺栓塞阻塞指数 

分 类 号：R563.5[医药卫生—呼吸系统]