CT肺动脉栓塞指数在急性肺栓塞危险度评估中的临床价值

发布时间：2018-05-22 12:42

  本文选题：急性肺栓塞 + CT肺动脉栓塞指数　； 参考：《浙江大学》2017年硕士论文

【摘要】：背景与目的肺动脉栓塞是内源性或外源性栓子堵塞肺动脉或其分支引起的一种临床综合征,如何早期识别并及时处理急性肺栓塞是目前研究的重心,随着影像学技术的发展,CTPA已经成为诊断肺栓塞的主要方法,多项研究已证明CT肺动脉栓塞指数对于预测急性肺栓塞患者的预后有重要影响,本文旨在通过分析肺动脉栓塞指数与急性肺栓塞危险度,以及与实验室相关指标和影像学相关参数的关系,探讨肺动脉栓塞指数在急性肺栓塞患者危险度评估中的价值方法回顾性收集邵逸夫医院2013年1月到2017年1月之间首次诊断为急性肺血栓栓塞的患者77例,根据2014ESC指南中的危险度分类,将这部分人群分成低危组(A组)、中低危组(B组)、中高危和高危组(C组),根据患者的CTPA表现,分别计算每组患者的Qanadli及Mastora肺动脉栓塞指数,比较不同组间CT肺动脉栓塞指数的差异,并比较相关参数与CT肺动脉栓塞指数的相关性。结果1.C组患者的晕厥比例明显高于其他两组。2.肺栓塞患者的动脉血气中,PaC02及氧合指数均随着肺栓塞危险度上升呈逐渐下降趋势。NT-proBNP、cTn Ⅰ在中高及高危患者中明显升高。3.RVSP、MPA/AA、RV/LV随着肺栓塞危险度增加,呈逐渐升高趋势,其中RVSP、MPA/AA在A、B、C三组中均存在统计学差异,RV/LV在A组与B组及C组比较时有统计学差异,而在B组与C组比较时无明显统计学差异。4.Qanadli及Mastora肺动脉栓塞指数均随着肺栓塞危险度升高而呈上升趋势,三组间比较均存在统计学差异。Qanadli及Mastora栓塞指数与脉搏、DDI、NT-proBNP、cTnI、RV/LV之间存在正相关,相关系数范围分别为0.318～0.526;0.231～0.570。与PaC02、氧合指数、LVEF呈负相关,相关系数范围分别为-0.310～-0.368;-0.318～-0.345。其中,Qanadli及Mastora栓塞指数均与cTnI相关性最大,相关系数分别为0.526、0.570。5.将患者分成中高危+高危组、低危+中低危组,对Qanadli及Mastora栓塞指数行ROC曲线得出,Qanadli及Mastora栓塞指数对于区别两组具有较高的灵敏度和特异度。结论1.Qanadli及Mastora栓塞指数均与急性肺栓塞患者的危险度呈相关性,Qanadli及Mastora栓塞指数与临床多项参数存在相关性2.Qanadli栓塞指数截断值24%或Mastora栓塞指数截断值17%,对于区别高危组+中高危组及低危组+中低危组具有较高的灵敏度和特异度。3.CT肺动脉栓塞指数对于早期评估肺栓塞的危险度,指导进一步治疗方面存在重要的临床意义。
[Abstract]:Background & objective Pulmonary embolism is a kind of clinical syndrome caused by endogenous or exogenous embolus blocking pulmonary artery or its branches. How to identify and deal with acute pulmonary embolism early and timely is the focus of current research. With the development of imaging techniques, CTPA has become the main method for the diagnosis of pulmonary embolism. Several studies have proved that CT pulmonary embolism index plays an important role in predicting the prognosis of patients with acute pulmonary embolism. The aim of this study was to analyze the relationship between pulmonary embolism index and acute pulmonary embolism risk, laboratory and imaging parameters. To explore the value of pulmonary embolism index in risk assessment of patients with acute pulmonary embolism methods A retrospective study was made on 77 patients with acute pulmonary thromboembolism diagnosed for the first time between January 2013 and January 2017 in Shaw Hospital. According to the classification of risk in 2014ESC guidelines, this group was divided into three groups: group A in low risk group, group B in low risk group, group C in middle high risk group and high risk group. According to the CTPA manifestation of patients, the Qanadli and Mastora pulmonary embolism index of each group were calculated respectively. To compare the difference of CT pulmonary embolism index between different groups, and to compare the correlation between relevant parameters and CT pulmonary embolism index. Results 1. The rate of syncope in group C was significantly higher than that in the other two groups. 2. PaC02 and oxygenation index in arterial blood gas of pulmonary embolism patients showed a decreasing trend with the increase of pulmonary embolism risk. NT-proBNPcTn 鈪，

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