急性肺栓塞的CT肺动脉阻塞指数与多项生化指标的相关性研究

发布时间：2019-03-27 12:25

【摘要】：背景：肺栓塞（acute pulmonary cmbolismPE）是一种发病率和死亡率均较高的疾病，有研究表明，近年来我国肺栓塞数量正在逐年增加，因此在对PE做出正确诊断的同时，，需对其病情的严重程度进行相关的评估，为临床的治疗决策、疗效评价及预后判断等提供客观、科学依据。目的：利用CT肺动脉造影（CT pulmonary angiography CTPA）的“CT肺动脉阻塞指数”定量分析PE患者肺动脉阻塞的程度；研究“CT肺动脉阻塞指数”和动脉血气分析、心肌标志物及凝血指标之间的关系，并评价PE的严重度。方法：回顾性分析我院2009年11月至2011年9月通过我院双源CT肺动脉造影成像确诊肺栓塞的24例入院患者。采用Spearman等级相关系数评价CT阻塞指数与各项生化指标之间的相关性；用Mann-Whitney U检验来评价高于或低于不同CT肺动脉阻塞指数（35%，45%，55%，65%）时的各项生化指标之间是否有统计学差异。结果： 1、肺动脉阻塞程度和动脉血气分析中PaO2、P (A-a)O2存在相关性，且PaO2、P (A-a)O2可以对肺动脉阻塞严重性进行评估。PE患者的PO2、P (A-a)O2在CTI%为55%、65%阈值水平上下差异有显著意义， 2、肺动脉阻塞程度和凝血指标、D-Dimer之间存在相关性，相关性依次为APTT、INR、D-dimer、PT，并可以通过这四个化验指标对肺动脉阻塞严重行进行评估。APTT在PE患者CTI%为55%、65%阈值上下时比PT、INR、D-Dimer更敏感；而当PE患者CTI%为35%为时PT较其他三项更加敏感。 3、肺动脉阻塞程度和心肌标志物中的ALT、AST、LDH之间存在相关性，且以AST相关性最大，ALT次之，LDH最小，并可以通过此三项化验指标对肺动脉阻塞严重行进行评估。 ALT、AST在PE患者CTI%为35%阈值上下时较LDH敏感，在PE患者CTI%为45%、55%、65%阈值上下时ALT、AST、LDH同样敏感。结论：动脉血气分析、凝血功能指标、D-dimer、心肌标志物与CT肺动脉阻塞指数之间有相关性，并可以定量化评估急性肺动脉栓塞的严重程度。
[Abstract]:Background: pulmonary embolism (acute pulmonary cmbolismPE) is a disease with high morbidity and mortality. Studies have shown that the number of PE in China is increasing year by year in recent years. Therefore, the correct diagnosis of PE is made at the same time. It is necessary to evaluate the severity of the disease in order to provide objective and scientific basis for clinical treatment decision, curative effect evaluation and prognosis judgment. Objective: to quantitatively analyze the degree of pulmonary artery obstruction in patients with PE by using the "CT pulmonary artery occlusion index" of (CT pulmonary angiography CTPA) on CT pulmonary angiography. To study the relationship between "CT pulmonary artery occlusion index" and arterial blood gas analysis, myocardial markers and coagulation indexes, and to evaluate the severity of PE. Methods: from November 2009 to September 2011, 24 patients with pulmonary embolism diagnosed by dual-source CT pulmonary angiography were retrospectively analyzed. Spearman grade correlation coefficient was used to evaluate the correlation between CT blocking index and biochemical indexes. Mann-Whitney U test was used to evaluate whether there were statistical differences between the biochemical indexes of different CT pulmonary artery occlusion indexes (35%, 45%, 55%, 65%). Results: 1. There was a correlation between the degree of pulmonary artery obstruction and PaO2,P (a) O 2 in arterial blood gas analysis, and the severity of pulmonary artery obstruction could be evaluated by PaO2,P (a) O 2. PO2, in PE patients P (A _ (a) O _ 2) was 55% in CTI% and 65% in threshold level. 2, the degree of pulmonary artery obstruction was correlated with coagulation index and D-Dimer, and the correlation in turn was APTT,INR,D-dimer,PT,. These four indexes can be used to evaluate the severe pulmonary artery obstruction. APTT is 55% of CTI% in patients with PE, and more sensitive than PT,INR,D-Dimer when the threshold of 65% is above or below the threshold. When CTI% was 35% in PE patients, PT was more sensitive than the other three items. (3) there was a correlation between the degree of pulmonary artery obstruction and ALT,AST,LDH in myocardial markers, and the correlation of AST was the highest, ALT was the second, and LDH was the least, and the severity of pulmonary artery obstruction could be evaluated by these three indexes. ALT,AST was more sensitive than LDH when CTI% was 35% or lower in PE, 45%, 55% and 65% in PE, respectively. ALT,AST,LDH was also sensitive when CTI% was above or below the threshold of 65%. Conclusion: arterial blood gas analysis, coagulation function, D-dimer and myocardial markers are correlated with CT pulmonary artery occlusion index, and the severity of acute pulmonary embolism can be quantitatively evaluated.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.5

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