CT肺动脉成像评价肺动脉球囊扩张成形术治疗慢性血栓栓塞性肺动脉高压的疗效  

Applicability study of CT pulmonary angiography in evaluating treatment effect after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

作　　者：卢志辉 张臣[1] 万钧 肖瑶[2] 赵蕾[3] 鹿冠玉 张洪博 王兰菱 马晓海[1] Lu Zhihui;Zhang Chen;Wan Jun;Xiao Yao;Zhao Lei;Lu Guanyu;Zhang Hongbo;Wang Lanling;Ma Xiaohai(Department of Interventional Diagnosis and Treatment,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Respiratory and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院介入诊疗科,北京100029 [2]首都医科大学附属北京安贞医院呼吸与危重症医学科,北京100029 [3]首都医科大学附属北京安贞医院医学影像科,北京100029

出　　处：《中华放射学杂志》2025年第4期447-453,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(82071875);北京市自然科学基金(7212025,7222302)。

摘　　要：目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者经肺动脉球囊扩张成形术(BPA)治疗后,CT肺动脉成像(CTPA)相关参数的变化与疗效的相关性。方法回顾性纳入2021年11月至2024年2月首都医科大学附属北京安贞医院行BPA治疗的CTEPH患者43例。分析患者术前(首次BPA治疗)与术后(末次治疗后至少6个月)的临床资料、CTPA相关参数。其中临床资料包括WHO心功能分级、6分钟步行距离(6MWD)及血浆N-末端脑钠肽前体(NT-proBNP)。CTPA相关参数包括主肺动脉最宽直径(dPA)、升主动脉直径(dAA)、右心房最宽横径(dRA)、右心室最长短轴径(dRV)、左心室最长短轴径(dLV)及右心室游离壁厚度(dRVW)。评估包括平均动脉压(mPAP)在内的多个血流动力学参数。比较BPA治疗前后患者各评估指标的改变,并采用多元线性回归评估CTPA参数中与mPAP改变相关的因素。结果所有CTEPH患者共计行115次BPA治疗。术后患者WHO心功能分级较术前改善(χ^(2)=5.01,P<0.001),6MWD较术前改善(t=4.50,P<0.001),血浆NT-proBNP较术前降低(Z=4.47,P<0.001)。术后mPAP、肺血管阻力、心输出量及心指数等血流动力学参数较术前均显著改善(P均<0.001)。术后dPA、dRA、dRV、dRVW、dPA/dAA、dRV/dLV、dRA/dPA等CTPA相关参数较术前也显著降低(P均<0.001)。多元线性回归分析显示,dPA(β=0.314,P=0.037)与dRA(β=0.334,P=0.046)的降低与mPAP的改善显著相关。结论CTEPH患者的运动耐量、血流动力学及CTPA相关参数经BPA治疗后得到显著改善。dPA与dRA的降低与CTEPH患者mPAP的改善具有显著相关性,CTPA望成为一种全新的,能够客观、有效且无创评价BPA疗效的检查方式。ObjectiveTo investigate whether changes in CT pulmonary angiography(CTPA)parameters before and after balloon pulmonary angioplasty(BPA)are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension(CTEPH).MethodsA retrospective study was conducted,including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024.Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session.Clinical data included WHO functional class,6-minute walk distance(6MWD),and plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)levels.The CTPA parameters included the widest diameter of the pulmonary artery diameter(dPA),ascending aorta diameter(dAA),the widest transverse diameter of the right atrium(dRA),the widest short-axis diameter of the right ventricle(dRV),the widest short-axis diameter of the left ventricle(dLV),and the diameter of right ventricular free wall thickness(dRVW).Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure(mPAP)among the CTPA parameters.ResultsAll CTEPH patients underwent a total of 115 BPA treatments.Postoperatively,the WHO functional class of the patients improved compared to preoperative levels(χ^(2)=5.01,P<0.001),6MWD improved(t=4.50,P<0.001),and NT-proBNP levels decreased(Z=4.47,P<0.001).Hemodynamic parameters,including mPAP,pulmonary vascular resistance,cardiac output,and cardiac index,were significantly improved postoperatively(all P<0.001).CTPA-related parameters,including dPA,dRA,dRV,dRVW,dPA/dAA,dRV/dLV,and dRA/dPA,significantly decreased compared to preoperative values(all P<0.001).Multiple linear regression analysis showed that the decrease in dPA(β=0.314,P=0.037)and dRA(β=0.334,P=0.046)were significantly correlated with the improvement in mPAP.ConclusionsExercise tolerance,hemodynamics,and CTPA parameters in patients with CTEPH significantly improved after BPA trea

关 键 词：高血压 肺性 肺动脉球囊扩张成形术 血栓栓塞 CT肺动脉成像 

分 类 号：R543.2[医药卫生—心血管疾病]