MSCTPA评估急性肺栓塞严重程度及预后的价值分析  

Value of MSCTPA in Evaluating the Severityand Prognosis of Acute PulmonaryEmbolism

作　　者：薛雅东 刘健[1] 王汉卿[1] 田佳明 徐鹏[1] XUE Ya-dong;LIU Jian;WANG Han-qing;TIAN Jia-ming;XU Peng(Medical Imaging Center,The First Affiliated Hospital of Jiamusi University,Jiamusi 154003,Heilongjiang Province,China)

机构地区：[1]佳木斯大学附属第一医院医学影像中心,黑龙江佳木斯154003

出　　处：《中国CT和MRI杂志》2025年第4期83-86,共4页Chinese Journal of CT and MRI

摘　　要：目的分析多层螺旋CT肺动脉造影(MSCTPA)对急性肺栓塞(APE)严重程度及预后的评估价值。方法回顾性选取2022年9月至2024年9月医院收治的APE患者203例,均行MSCTPA检查,根据肺栓塞严重指数(PESI)将患者分为高危组(n=51)及低危组(n=152),另外依据住院期间预后情况将患者分为生存组(n=35)及死亡组(n=168),对比高危组及低危组右心室短轴最大径(RVMAS)、左心室短轴最大径(LVMAS)、RV/LV及肺动脉直径,采用Pearson相关性分析MSCTPA定量参数与APE严重程度的关系;采用单因素及多因素Logistic回归分析APE患者不良预后的影响因素,以受试者工作特征(ROC)曲线分析MSCTPA定量参数对不良预后的预测价值。结果高危组、低危组LVMAS比较无明显差异(P>0.05),高危组PESI总分、CT肺动脉阻塞指数、RVMAS、RV/LV、肺动脉直径均高于低危组(P<0.05)。Pearson相关性分析结果显示,CT肺动脉阻塞指数、RVMAS、RV/LV、肺动脉直径呈正相关(r=0.563、0.527、0.435、0.401,P<0.05)。死亡组、生存组LVMAS比较无明显差异(P>0.05),死亡组PESI总分、CT肺动脉阻塞指数、RVMAS、RV/LV、肺动脉直径均高于生存组(P<0.05)。多因素Logistic回归分析结果显示,CT肺动脉阻塞指数(OR=1.603,95%CI:1.060~2.424)、RVMAS(OR=1.667,95%CI:1.089~2.551)、RV/LV(OR=2.440,95%CI:1.154~5.159)、肺动脉直径(OR=1.824,95%CI:1.064~3.127)为APE患者死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,MSCTPA定量参数联合预后APE患者预后的AUC、特异度及灵敏度分别为0.928、88.60%、97.00%,均高于单一指标(P<0.05)。结论MSCTPA可评估APE患者的严重程度及预后。Objective To analyze the value of multislice computed tomographic pulmonary angiography(MSCTPA)in evaluating the severity and prognosis of acute pulmonary embolism(APE).Methods A total of 203 patients with APE admitted to the hospital from September 2022 to September 2024 were reviewed,and all of them underwent MSCTPA.According to the Pulmonary Embolism Severity Index(PESI),patients enrolled were divided into high-risk group(n=51)and low-risk group(n=152).They were divided into survival group(n=35)and death group(n=168)according to the prognosis during hospitalization.The maximum right ventricular short-axis diameter(RVMAS),maximum left ventricular short-axis diameter(LVMAS),RV/LV,and pulmonary artery diameter were compared between the high-risk group and the low-risk group.Pearson correlation analysis was performed to discuss the relationship between quantitative parameters of MSCTPA and the severity of APE.Single factor analysis and multi-factor logistic regression analysis were performed to screen factors influencing poor prognosis of APE.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of quantitative parameters of MSCTPA for poor prognosis.Results LVMAS of the highrisk group and the low-risk group was similar(P>0.05).Total PESI score,pulmonary artery obstruction index assessed with CT,RVMAS,RV/LV,and pulmonary artery diameter in the high-risk group were higher than those in the low-risk group(P<0.05).Pearson correlation analysis results showed that pulmonary artery obstruction index assessed with CT,RVMAS,RV/LV,and pulmonary artery diameter were positively correlated(r=0.563,0.527,0.435,0.401,P<0.05).LVMAS of the death group and the survival group was similar(P>0.05).Total PESI score,pulmonary artery obstruction index assessed with CT,RVMAS,RV/LV,and pulmonary artery diameter in the death group were higher than those in the survival group(P<0.05).Multi-factor logistic regression analysis results showed that pulmonary artery obstruction index assessed with CT(OR=1.603,9

关 键 词：急性肺栓塞 多层螺旋CT肺动脉造影 严重程度 预后 

分 类 号：R563.5[医药卫生—呼吸系统]