CT肺动脉成像对肺动脉高压分级的临床应用

发布时间：2018-03-16 07:30

本文选题：肺动脉高压　切入点：分级　出处：《川北医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:利用CT肺动脉成像(Computed tomography pulmonary angiography,CTPA)探讨肺动脉相关参数与肺动脉高压(pulmonary hypertension,PH)之间的相关性,并筛选出与PH相关性较高的参数,探讨其对PH分级的价值。方法:本研究经川北医学院伦理委员会的批准;按照多普勒超声心动图根据测算肺动脉收缩压(pulmonary artery systolic pressure,PASP)对PH进行诊断及分级的标准,选取2013年1月至2016年9月间至川北医学院附属医院就诊的PH患者100例(PH患者组)及同时期肺动脉压力正常的受检者30例(正常对照组),同时将PH患者分为轻度组(45例)、中度组(42例)和重度组(13例),排除碘过敏及病危不能耐受检查者。在CTPA图像上测量其肺动脉干(the main pulmonary artery inner diameter,MPAD)、同层面升主动脉(the aortic inner diameter,AD)、右肺动脉干(the right pulmonary artery inner diameter,RPAD)、右下肺动脉干(right lower pulmonary artery inner diameter,RLPAD)、右肺下叶后基底段动脉及左肺动脉干(the left pulmonary artery inner diameter,LPAD)、左肺下叶后基底段动脉的内径,计算肺动脉干与升主动脉内径的比值(the main pulmonary artery inner diameter/aortic inner diameter,PA/A)。计量资料采用成组t检验,采用单因素方差分析法比较轻、中、重度PH患者各肺动脉相关参数的差异,采用LSD法分析肺动脉相关参数两两之间的差异,采用Spearman等级相关分析各肺动脉相关参数与PH之间的相关性,采用受试者工作特征曲线(the receiver operating characteristic,ROC)确立与PH相关性较高的肺动脉相关参数于轻、中、重度PH患者组的各自最佳阈值。结果:(1)肺动脉相关参数在正常对照组与PH患者组的差异具有统计学意义(p0.05);(2)轻、中、重度PH患者组的各肺动脉相关参数之间的差异具有统计学意义(p0.05);(3)两两比较中,轻、中、重度PH患者组的MPAD、PA/A、RLPAD及右肺下叶后基底段动脉内径的两两比较均具有统计学意义(p0.05),且与PH相关性较高,相关系数分别为0.454,0.669,0.433,0.496(p0.05)。(4)轻、中及重度PH患者组的各自最佳阈值均不同(p0.05):MPAD分别为26.04mm、29.78mm、32.54mm,ROC曲线下的面积(area under the ROC curve,AUC)分别为0.920、0.727、0.756;PA/A分别为0.76、0.94、1.05,AUC值分别为0.677、0.851、0.745;RLPAD分别为14.71mm、17.33mm、17.53mm,AUC值分别为0.719、0.684、0.687;右肺下叶后基底段动脉分别为2.40mm、3.37mm、4.38mm,AUC值分别为0.660、0.668、0.777。结论:CTPA可以诊断PH,并可用于PH的分级;右肺下叶后基底段动脉内径的变化可作为PH诊断及分级新的参考指标,并协助其他指标对PH分级的诊断。
[Abstract]:Objective: to investigate the correlation between pulmonary artery related parameters and pulmonary hypertension (PH) by computed tomography pulmonary angiography (CTPA), and to screen the parameters with high correlation with PH. Methods: this study was approved by the Ethics Committee of North Sichuan Medical College, and the criteria for the diagnosis and grading of PH were determined by Doppler echocardiography according to pulmonary artery systolic pressure. From January 2013 to September 2016, 100 patients with PH were selected from affiliated Hospital of North Sichuan Medical College, and 30 patients with normal pulmonary artery pressure at the same time (normal control group). At the same time, PH patients were divided into mild group. 45 cases of pulmonary artery, 42 cases of moderate group) and 13 cases of severe group were excluded from the examination of iodine allergy and critical condition. The main pulmonary artery inner diameterus MPAD were measured on CTPA images, the aortic inner diameterus adterna, the right pulmonary artery of the right pulmonary artery were measured on CTPA images. Inner diameterus, right lower pulmonary artery inner diameterus, posterior basilar artery of right inferior lobe and trunk of left pulmonary artery, inner diameter of left inferior lobe posterior basilar artery, left pulmonary artery, left inferior lobe posterior basilar artery, left inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery and left pulmonary artery. The ratio of the diameter of the pulmonary artery to the ascending aorta was calculated and the main pulmonary artery inner diameter/aortic inner diametera A / A were calculated. The measured data were measured by group t test, and the difference of the pulmonary artery related parameters among the patients with moderate, moderate and severe PH was compared by single factor variance analysis. LSD method was used to analyze the difference of pulmonary artery correlation parameters, and Spearman grade correlation was used to analyze the correlation between pulmonary artery related parameters and PH. Using the receiver operating characteristic curve to determine the pulmonary artery parameters with high correlation with PH. Results the difference of pulmonary artery related parameters between the normal control group and the PH group was statistically significant (p 0.05). The difference of pulmonary artery related parameters among patients with severe PH was statistically significant (p 0.05). In the patients with severe PH, the MPADPA / Agna RLpad and the right inferior lobar posterior basilar artery diameter were significantly higher than those in the right inferior lobar artery, and the correlation with PH was relatively high, the correlation coefficient was 0.454 卤0.669U 0.433U 0.496p0.05n.4The correlation coefficient was 0. 454 ~ 0. 669 ~ 0. 433nr 0. 496p0. 05 / 0. 4). The optimum threshold values of moderate and severe PH patients were different. The area area under the ROC AUC under the ROC curve were 26.04mm / 29.78mm and 32.54mmROC, respectively. The area under ROC ROC AUC / A was 0.9200.27270.756 / A = 0.760.7941.05AUC = 0.6770.851AUC = 14.71mm 17.33mm 17.53mmA, respectively, and the right sublobar posterior basilar artery was 2.40mm / 3.37mm / 4.38mmA respectively. The values were 0.660 ~ 0.668 ~ 0.777.Conclusion: 1. CTPA can be used in the diagnosis of PH and in the grading of PH. The change of right inferior lobe posterior basilar artery diameter can be used as a new reference index for the diagnosis and grading of PH and assist other indexes in the diagnosis of PH grade.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R816.2

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