CT肺栓塞指数在肺栓塞患者中的临床应用研究
Clinical significance of CT pulmonary embolism index in patients with pulmonary embolism

刘波.CT肺栓塞指数在肺栓塞患者中的临床应用研究[J].内科急危重症杂志,2015,21(6):

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英文关键词:pulmonary embolism CT pulmonary embolism index computerized tomography pulmonary angiography risk stratification

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作者	单位	E-mail
刘波	武汉亚洲心脏病医院	2325709848@qq.com

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中文摘要:

目的：探讨CT肺栓塞指数在肺栓塞患者中的临床应用价值。方法：入选我院2011.01-2015.01通过双源CT肺动脉造影确诊的187例肺栓塞患者，132例为急性肺栓塞，55例为慢性肺栓塞；急性肺栓塞中，低危组46例，中危组86例，高危组0例。通过CT影像计算CT肺栓塞指数，结合肺栓塞危险分层绘制两者的受试者工作曲线（ROC曲线）并得到最佳诊断阈值，按对应的CT肺栓塞指数将急、慢性肺栓塞患者分别划分为两组，对比分析两组在各个研究要素上有无统计学差异并进行讨论。结果：1、急性肺栓塞中，低危组平均CT肺栓塞指数为37.5±27.4%，中危组平均CT肺栓塞指数为50.8±23.9%，差异具有统计学意义；慢性肺栓塞平均CT肺栓塞指数为23.1±21.9%。2、CT肺栓塞指数与危险分层的ROC曲线下面积为0.653（P=0.004），最佳诊断阈值对应的CT肺栓塞指数为60%。3、急、慢性肺栓塞患者的CT肺栓塞指数在性别、年龄分布上均没有统计学差异。4、急性肺栓塞中，与CT肺栓塞指数＜60%组相比，CT肺栓塞指数≥60%组出现呼吸困难及晕厥症状比例更多，心率更快，PaO2、SaO2、PaCO2降低，P(A-a)O2增高，WBC、NEUT、HsCRP增高，cTnI、BNP、D-二聚体增高，RA、RV、RV/LV增高。两组在收缩压、舒张压方面未表现出统计学差异。5、慢性肺栓塞中，与CT肺栓塞指数＜60%组相比，CT肺栓塞指数≥60%组出现呼吸困难症状比例更多，PaO2、SaO2、PaCO2降低，P(A-a)O2增高， HsCRP、D-二聚体增高，RA、RV、RV/LV增高。两组在收缩压、舒张压及心率方面未表现出统计学差异。6、无论是急性或是慢性肺栓塞，CT肺栓塞指数≥60%组的PESI评分均高于CT肺栓塞指数＜60%组，两组差异均有统计学意义。结论：CT肺栓塞指数与肺栓塞危险分层具有显著的相关性，两者ROC曲线的最佳诊断阈值所对应的CT肺栓塞指数为60%。以60%为界，CT肺栓塞指数可良好区分急、慢性肺栓塞患者的病情严重程度及预后评分，说明CT肺栓塞指数在急、慢性肺栓塞患者中均具有一定的临床应用价值。

英文摘要:

Objective: To assess the clinical significance of CT pulmonary embolism index (CTI) in patients with pulmonary embolism (PE).Methods: One hundred thirty-two consecutive patients with pulmonary embolism confirmed by dual-source computerized tomography pulmonary angiography (CTPA) were selected at our institution from January 2011 to January 2015. The receiver operating characteristic curve (ROC curve) was computed by CTI and risk stratification of PE to explore the best diagnostic threshold and the corresponding CTI. According to the corresponding CTI, we divided acute and chronic PE patients into two groups to compare and discuss whether there is statistical difference in each research element.Results: 1. Among the 132 acute PE patients, The CTI values of low-risk group(n=46) and intermediate-risk group(n=86) were 26.2±16.4%, 52.9±10.6%, respectively. The CTI values of chronic PE patients(n=55) were 23.1±21.9%.2. The area under the ROC curve of CTI and risk stratification was 0.653(P=0.004) and the corresponding CTI to the best diagnostic threshold was 60%.3. CTI on the gender and age distribution had no statistical difference in both acute and chronic PE patients.4. Comparing to the group of CTI＜60% in acute PE, the group of CTI≥60% was more likely to present dyspnea and syncope, with higher heart rate, P(A-a)O2, WBC, NEUT, HsCRP, cTnI, BNP, D-dimer, and the size of RA, RV and RV/LV, but lower PaO2, SaO2, PaCO2. The two groups in terms of systolic and diastolic pressure showed no statistical difference.5. Comparing to the group of CTI＜60% in chronic PE, the group of CTI≥60% was more likely to present dyspnea, with higher P(A-a)O2, HsCRP, D-dimer, and the size of RA, RV and RV/LV, but lower PaO2, SaO2, PaCO2. The two groups in terms of systolic pressure, diastolic pressure and heart rate showed no statistical difference. 6. The PESI score in CTI＜60% group was statistically higher than that in CTI≥60% group in both acute and chronic PE patients.Conclusion: CTI had significant correlation with PE risk stratification. The corresponding CTI to the best diagnostic threshold of ROC curve for CTI and risk stratification was 60%. The severity and prognosis score in acute and chronic PE patients could be well distinguished based on whether or not the CTI was more than 60%. Our findings indicated that there was certain clinical value for CTI in both acute and chronic PE patients.