CT评估肺小血管参数对慢性阻塞性肺疾病急性加重患者并发肺动脉高压的预测价值  

The predictive value of small pulmonary vessel parameters evaluated by CT for pulmonary hypertension in the patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：钱骏 孙凯[1] Qian Jun;Sun Kai(Emergency Department,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急诊科,江苏南京210029 [2]南京医科大学附属逸夫医院急诊科,江苏南京210029

出　　处：《中国急救医学》2025年第3期232-236,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金项目(81871544)。

摘　　要：目的探讨CT评估肺小血管参数对慢性阻塞性肺疾病急性加重(AECOPD)患者并发肺动脉高压(PH)的预测价值。方法回顾性筛选2021年9月至2024年3月于南京医科大学第一附属医院急诊科收治的AECOPD患者141例,根据是否合并PH分为合并组(n=62)和对照组(n=79)。采集性别、年龄、体重指数(BMI)、住院时间、AECOPD严重程度、生活习惯史、基础疾病史、用药史、实验室指标等,CT评估肺小血管横截面积(CSA)。Logistic回归分析AECOPD患者并发PH的影响因素,ROC曲线分析CSA对AECOPD患者并发PH的预测价值。结果合并组住院时间、抗菌药物疗程长于对照组(P<0.05),AECOPD严重程度(Ⅱ级、Ⅲ级)占比、血白细胞(WBC)、血红蛋白(Hb)、D-二聚体(D-dimer)、动脉血二氧化碳分压(PaCO_(2))、横截面积5~10 mm^(2)的肺小血管百分比(%CSA 5~10)高于对照组(P<0.05),淋巴细胞计数(LYM)、横截面积<5 mm^(2)的肺小血管百分比(%CSA<5)低于对照组(P<0.05)。Logistic回归分析显示,LYM(OR=0.046,95%CI 0.011~0.321)、Hb(OR=1.065,95%CI 1.017~1.567)、%CSA<5(OR=0.043,95%CI 0.011~0.674)、%CSA 5~10(OR=1.332,95%CI 1.023~4.443)为AECOPD患者并发PH的影响因素(P<0.05)。ROC曲线分析显示,%CSA<5对AECOPD患者并发PH的预测效能较%CSA 5~10略高[AUC:0.771(0.667~0.875)vs.0.680(0.568~0.792)],%CSA<5的预测敏感度为0.875,特异度为0.745,约登指数为0.620,P<0.001。结论%CSA<5与AECOPD患者并发PH之间存在一定的关联,在临床实践中可能具有一定的预测价值。Objective To investigate the predictive value of small pulmonary vessel parameters assessed by CT for pulmonary hypertension(PH)in the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 141 patients with AECOPD admitted to Emergency Department,the First Affiliated Hospital of Nanjing Medical University from September 2021 to March 2024 were retrospectively screened.According to whether PH occurred,they were divided into a combined group(n=62)and a control group(n=79).Gender,age,body mass index(BMI),length of hospital stay,the severity of AECOPD,the history of living habits,the history of underlying diseases,the history of medication and laboratory indicators were collected,small pulmonary vessel cross-sectional area(CSA)were evaluated by CT.Logistic regression analysis was used to analyze the influencing factors in the AECOPD patients with PH.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CSA for PH.Results The hospitalization time and a course of antibiotics in the combined group were longer than those in the control group(P<0.05).The proportion of AECOPD severity(gradeⅡand gradeⅢ),white blood cell(WBC),hemoglobin(Hb),D-dimer,arterial partial pressure of carbon dioxide(PaCO_(2))and%CSA 5~10 in the combined group were higher than those in the control group(P<0.05),while lymphocyte(LYM)and%CSA<5 in the combined group were lower than those in the control group(P<0.05).Logistic regression analysis showed that LYM(OR=0.046,95%CI 0.011-0.321),Hb(OR=1.065,95%CI 1.017-1.567),%CSA<5(OR=0.043,95%CI 0.011-0.674),%CSA 5~10(OR=1.332,95%CI 1.023-4.443)were the influencing factors in the AECOPD patients with PH(P<0.05).ROC curve analysis showed that%CSA<5 had a slightly higher predictive efficiency than%CSA 5~10 in the patients with PH[AUC 0.771(0.667-0.875)vs.0.680(0.568-0.792)],with the sensitivity of 0.875,the specificity of 0.745,Youden index of 0.620,P<0.001.Conclusions%CSA<5 is associated with PH in the AECOPD patients,suggesti

关 键 词：慢性阻塞性肺疾病急性加重 肺动脉高压(PH) 肺小血管 胸部CT 

分 类 号：R563.9[医药卫生—呼吸系统] R544.1[医药卫生—内科学]