CAT评分与胸部CT血管测量在COPD相关肺动脉高压预测中的价值分析

发布时间：2018-02-09 09:40

本文关键词： CAT评分胸部CT血管测量肺动脉高压阈值　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的了解CAT评分、主肺动脉直径(MPAD)、主肺动脉/升主动脉直径比(rPA)、主肺动脉/降主动脉直径比(rPD)与COPD相关肺动脉高压的相关性,分析其对COPD相关肺动脉高压的预测价值。方法收集2015年12月至2016年6月安徽医科大学第一附属医院呼吸内科经过积极治疗,患者急性加重期症状稳定、缺氧改善时的COPD患者共174例。所有患者在入院时统计年龄、性别、吸烟情况、身高、体重等信息,在出院前一天于我院行心脏彩超和胸部CT检查,对其讲解CAT量表进行CAT评分。应用Carestream软件对胸部CT图像进行血管直径测量,依据测量结果分别计算出MPAD、rPA、rPD。根据心脏彩超结果将所有患者分为肺动脉压力正常组、轻度增高组、中—重度增高组三个组别,比较三组间年龄、性别、吸烟比例、体重指数(BMI)等一般资料。比较三组间CAT评分、MPAD、rPA、rPD的差异性,分析其与肺动脉压力的相关性。绘制ROC曲线,了解CAT评分、MPAD、rPA、rPD预测COPD相关肺动脉高压的阈值,分析其预测COPD相关肺动脉高压的价值,结果1.正常组、轻度增高组、中—重度增高组三个组别在年龄、性别、BMI方面的差异均无统计学意义(P0.05),在吸烟比例方面差异有统计学意义(P0.05)。2.轻度增高组的CAT评分、MPAD、rPD均高于正常组,差异有统计学意义(P0.05),rPA差异无统计学意义(P0.05);中—重度增高组的CAT评分、MPAD、rPA、rPD均高于正常组及轻度增高组,差异均有统计学意义(P0.05)。3.CAT评分、MPAD、rPA、rPD与肺动脉压力均成正相关,差异有统计学意义(P0.01)。4.CAT评分、MPAD、rPA、rPD预测COPD相关轻度肺动脉高压的阈值分别是21分、33.5 mm、0.95、1.12,预测COPD相关中—重度肺动脉高压的阈值分别是28分、35.5 mm、1.02、1.20。5.CAT评分联合MPAD、rPA、rPD预测COPD相关轻度肺动脉高压可兼顾灵敏度与特异度。CAT评分联合MPAD、rPA、rPD预测COPD相关中—重度肺动脉高压的灵敏度与特异度均较单项指标高结论CAT评分、MPAD、rPA、rPD可作为COPD相关肺动脉高压的预测指标。CAT评分联合胸部CT血管测量预测COPD相关肺动脉高压优于单一指标。当CAT评分21分、MPAD33.5 mm、rPA0.95、rPD1.12提示COPD患者并发轻度肺动脉高压。当CAT评分28分、MPAD35.5 mm、rPA1.02、rPD1.20提示COPD患者并发中—重度肺动脉高压。
[Abstract]:Objective to investigate the correlation between CAT score, aorta diameter, aorta / ascending aorta diameter ratio, aorta / descending aorta diameter ratio and COPD associated pulmonary hypertension. Methods from December 2015 to June 2016, the respiratory department of the first affiliated Hospital of Anhui Medical University was actively treated, and the symptoms of acute exacerbation were stable. There were 174 patients with COPD who had improved anoxia. All the patients had their age, sex, smoking status, height, weight and other information at the time of admission. The day before discharge, they were examined by echocardiography and chest CT in our hospital. Using Carestream software to measure the diameter of blood vessels in chest CT images and calculate the MPAD rPArPD. according to the results of echocardiography, all the patients were divided into two groups: normal pulmonary artery pressure group and slightly elevated pulmonary artery pressure group, according to the results of color Doppler echocardiography, all the patients were divided into two groups: normal pulmonary artery pressure group and slightly elevated pulmonary artery pressure group. The age, sex, smoking ratio, body mass index (BMI) of the three groups were compared. The differences of CAT score and pulmonary artery pressure were compared among the three groups, and the correlation between them and pulmonary artery pressure was analyzed. ROC curves were plotted. To understand the threshold value of CAT score in predicting COPD associated pulmonary hypertension and analyze its value in predicting COPD associated pulmonary hypertension. 1. Age was observed in normal group, mild elevated group and moderate to severe elevated group. There was no significant difference in sex and BMI (P 0.05), but there was significant difference in smoking ratio (P 0.05). The CAT score of mild increase group was higher than that of normal group. There was no significant difference in CAT between moderate and severe elevated group (P 0.05). The CAT score of moderate to severe elevation group was significantly higher than that of normal group and mild elevated group, and the difference was statistically significant (P 0.05). 3. Cat score showed a positive correlation with pulmonary artery pressure. The threshold value of MPADrPARPD for predicting mild pulmonary hypertension associated with COPD was 21 / 33.5 mm / 0. 95 卤1.12, respectively. The thresholds for predicting moderate to severe pulmonary hypertension associated with COPD were 28 / 35.5 mm / 1. 02 卤1. 20. 5 cat scores combined with MPADrPArPD for predicting mild COPD correlation. The sensitivity and specificity of COPD associated moderate to severe pulmonary hypertension were higher than that of the single index. Conclusion CAT score and CAT score can be used as a predictor of COPD associated pulmonary hypertension. Cat score combined with chest CT angiography was superior to single index in predicting pulmonary hypertension associated with COPD. When CAT score was 21, MPAD33.5 mmPA0.95rPD1.12 indicated that COPD patients had mild pulmonary hypertension, and when CAT score 28, MPAD35.5 mmPA1.02rPD1.20 suggested that COPD patients complicated with pulmonary hypertension. -severe pulmonary hypertension.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R563.9

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