回顾性心电门控CTPA在APE危重程度评价中的应用研究
发布时间：2019-05-14 12:28
【摘要】：目的探讨回顾性心电门控CTPACT栓塞指数及心血管参数评价APE患者严重程度的临床价值。 方法经回顾性心电门控CTPA检查的患者65例，根据其疾病的严重风险程度分为高风险APE组20例（组1），非高风险组25例（组2）以及对照组20例。对比分析组1、2间Qanadli栓塞指数以及三组间右室舒张末期容积RVEDV、收缩末期容积RVESV、右左室舒张末期容积比RVEDV/LVEDV、收缩末期容积比RVESV/LVESV、右室每搏输出量RVSV、右室射血分数RVEF、右室最大短径RVd4CH、右左室最大短径比RVd4CH/LVd4CH、主肺动脉直径、主肺动脉主动脉直径比、上腔静脉及奇静脉短径、室间隔形态及下腔静脉对比剂返流情况的差异，使用spearman等级相关分析CT栓塞指数与右心形态功能参数间的关系，利用ROC曲线确定回顾性心电门控CTPA所得各参数诊断APE严重程度的准确性、敏感度及特异度。 结果高风险APE组Qanadli栓塞指数(中位数31.25%)大于非高危APE组(中位数10.00%)。三组患者间各右心功能参数在总体间均存在统计学差异，其中RVEDV、RVEDV/LVEDV、RVESV、RVESV/LVESV、RVd4CH/LVd4CH分别在三组患者间两两比较具有统计学差异。高风险组及非高风险组总体肺动脉栓塞指数与右心功能计量参数间均存在不同程度轻至中度相关关系（rs=0.194~0.503），其中RVSV、RVEF与Qanadli栓塞指数间呈负相关关系（rs=-0.400~-0.360）；高风险组各右心计量指标与栓塞指数间存在轻至中度相关关系；非高风险组右心功能计量指标与栓塞指数间呈轻度相关关系，，其中肺动脉主干宽度、主肺动脉直径比、上腔静脉短径以及奇静脉短径在非高风险组P＞0.05，差异无统计学意义。Qanadli栓塞指数、RVEDV、RVEDV/LVEDV、RVESV、RVESV/LVESV、RVEF、RVd4CH、RVd4CH/LVd4CH、Daz的ROC曲线下面积均大于0.5，其中RVESV/LVESV的Az值最大，为0.977。 结论回顾性心电门控CTPA可用于APE患者疾病严重程度的评价，为临床APE患者病情的正确评估、治疗方案的选择与调整以及预后的预测评价提供影像学依据。
[Abstract]:Objective to investigate the clinical value of retrospective ECG gated CTPACT embolism index and cardiovascular parameters in evaluating the severity of APE patients. Methods 65 patients undergoing ECG gated CTPA were divided into high risk APE group (n = 20), non-high risk group (n = 25) and control group (n = 20) according to the serious risk degree of ECG. Comparison and analysis of Qanadli embolic index between two groups and right ventricular end-diastolic volume RVEDV, end-systolic volume RVESV, right left ventricular end-diastolic volume RVESV, right ventricular end-diastolic volume compared with RVESV/LVESV, right ventricular stroke volume RVSV, right ventricular ejection fraction RVEF, Right ventricular maximum short diameter RVd4CH, right left ventricular maximum short diameter ratio RVd4CH/LVd4CH, main pulmonary artery diameter ratio, superior vena cava and azygos vein short diameter, interventricular septum morphology and inferior vena cava contrast agent reflux. The relationship between CT embolism index and right ventricular morphological function parameters was analyzed by spearman grade correlation analysis. The accuracy, sensitivity and specificity of each parameter obtained by retrospective ECG gated CTPA in the diagnosis of APE severity were determined by ROC curve. Results the Qanadli embolism index of high risk APE group (median 31.25%) was higher than that of non-high risk APE group (median 10.00%). There were significant differences in right ventricular function parameters among the three groups, and RVEDV,RVEDV/LVEDV,RVESV,RVESV/LVESV,RVd4CH/LVd4CH was significantly different among the three groups. There was a mild to moderate correlation between the total pulmonary embolism index and the measurement parameters of right ventricular function in high risk group and non-high risk group (rs=0.194~0.503). Among them, RVSV, was found to be mild to moderate. There was a negative correlation between RVEF and Qanadli embolism index (rs=-0.400~-0.360). There was a mild to moderate correlation between the right heart measurement index and the embolism index in the high risk group. There was a slight correlation between the measurement index of right ventricular function and embolism index in the non-high risk group, in which the width of the main pulmonary artery, the ratio of the diameter of the main pulmonary artery, the short diameter of the superior vena cava and the short diameter of azygos vein were significantly higher than those in the non-high risk group (P > 0.05). There was no significant difference. Qanadli embolism index, the area under the ROC curve of RVEDV,RVEDV/LVEDV,RVESV,RVESV/LVESV,RVEF,RVd4CH,RVd4CH/LVd4CH,Daz was more than 0.5, among which the Aze value of RVESV/LVESV was the largest (0.977). Conclusion retrospective ECG gated CTPA can be used to evaluate the severity of APE patients, and provide imaging basis for the correct evaluation of clinical APE patients, the selection and adjustment of treatment schemes and the prediction and evaluation of prognosis.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R563.5;R816.41
本文编号：2476715
[Abstract]:Objective to investigate the clinical value of retrospective ECG gated CTPACT embolism index and cardiovascular parameters in evaluating the severity of APE patients. Methods 65 patients undergoing ECG gated CTPA were divided into high risk APE group (n = 20), non-high risk group (n = 25) and control group (n = 20) according to the serious risk degree of ECG. Comparison and analysis of Qanadli embolic index between two groups and right ventricular end-diastolic volume RVEDV, end-systolic volume RVESV, right left ventricular end-diastolic volume RVESV, right ventricular end-diastolic volume compared with RVESV/LVESV, right ventricular stroke volume RVSV, right ventricular ejection fraction RVEF, Right ventricular maximum short diameter RVd4CH, right left ventricular maximum short diameter ratio RVd4CH/LVd4CH, main pulmonary artery diameter ratio, superior vena cava and azygos vein short diameter, interventricular septum morphology and inferior vena cava contrast agent reflux. The relationship between CT embolism index and right ventricular morphological function parameters was analyzed by spearman grade correlation analysis. The accuracy, sensitivity and specificity of each parameter obtained by retrospective ECG gated CTPA in the diagnosis of APE severity were determined by ROC curve. Results the Qanadli embolism index of high risk APE group (median 31.25%) was higher than that of non-high risk APE group (median 10.00%). There were significant differences in right ventricular function parameters among the three groups, and RVEDV,RVEDV/LVEDV,RVESV,RVESV/LVESV,RVd4CH/LVd4CH was significantly different among the three groups. There was a mild to moderate correlation between the total pulmonary embolism index and the measurement parameters of right ventricular function in high risk group and non-high risk group (rs=0.194~0.503). Among them, RVSV, was found to be mild to moderate. There was a negative correlation between RVEF and Qanadli embolism index (rs=-0.400~-0.360). There was a mild to moderate correlation between the right heart measurement index and the embolism index in the high risk group. There was a slight correlation between the measurement index of right ventricular function and embolism index in the non-high risk group, in which the width of the main pulmonary artery, the ratio of the diameter of the main pulmonary artery, the short diameter of the superior vena cava and the short diameter of azygos vein were significantly higher than those in the non-high risk group (P > 0.05). There was no significant difference. Qanadli embolism index, the area under the ROC curve of RVEDV,RVEDV/LVEDV,RVESV,RVESV/LVESV,RVEF,RVd4CH,RVd4CH/LVd4CH,Daz was more than 0.5, among which the Aze value of RVESV/LVESV was the largest (0.977). Conclusion retrospective ECG gated CTPA can be used to evaluate the severity of APE patients, and provide imaging basis for the correct evaluation of clinical APE patients, the selection and adjustment of treatment schemes and the prediction and evaluation of prognosis.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R563.5;R816.41
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