摘要
目的探讨CT肺动脉成像（CTPA）在特发性肺动脉高压（IPAH）中的诊断价值。方法回顾性分析2012年1月至2015年11月浙江大学医学院附属邵逸夫医院经右心漂浮导管检查（RHC）确诊的IPAH患者加例。对肺实质、肺问质、纵隔淋巴结、心包和胸膜腔在CTPA检查中的表现进行分析，并测量心血管管径，包括右心室及左心室短轴最大径和主肺动脉、右肺动脉、左肺动脉、右下肺动脉、升主动脉及降主动脉直径，计算主肺动脉直径与升主动脉直径比值（rPA）、升主动脉与降主动脉直径比值（rAD）及右心室与左心室短轴最大径比值（RV／LV）。采用Spearman相关分析比较性别、肺、淋巴结、心包及胸膜改变与肺动脉压（PAP）之间的相关性；采用独立样本t检验对轻中度肺动脉高压组（4例）与重度肺动脉高压组（16例）间各心血管径的测量与计算值进行比较分析；采用Pearson相关分析对不同年龄组（〈50岁和≥50岁）的肺动脉压进行比较分析。结果20例患者中，片状渗出性改变7例，灌注不均“马赛克征”表现5例，“小叶中心性磨玻璃样肺结节”样渗出3例，纵隔淋巴结肿大6例，心包积液10例，其中4例合并胸腔积液，支气管动脉扩张4例，继发右肺动脉干栓塞1例。有无胸腔积液出现两组间肺动脉压力差异有统计学意义（r值为0．445，P=0．049）；左室短轴最大径、左肺动脉直径、右肺动脉直径、升主动脉直径、降主动脉直径及rPA在轻中度与重度肺动脉高压间的差异有统计学意义（t值分别为3．194、-3．393、-7．771、10．299、11．394、-12．715；均P〈0．05）。不同年龄组的肺动脉压力差异有统计学意义（r值为-0．481，P=0．032）。结论CTPA检查是诊断IPAH非常重要的检查方法，两肺、纵隔、心包膜、胸膜腔的表现以及心血管管径的大小对IPAH诊断及压力的评估有重要的参考价
Objective To evaluate the diagnostic value of CT pulmonary artery （CTPA） imaging with idiopathic pulmonary artery hypertension （IPAH）. Methods A total of 20 patients with right heart catheterization （RHC） proven IPAH were retrospectively analyzed between January 2012 and November 2015. The imaging was analyzed including pulmonary parenchyma, pulmonary interstitial, mediastinal lymph nodes,pericardium and pleural cavity on the CTPA examination. Cardiovascular parameters were measured in CTPA including right ventricle biggest short axis diameter （RVD）, left ventricle biggest short axis diameter （LVD）, main pulmonary artery diameter （MPAD）, right pulmonary artery diameter （RPAD）, left pulmonary artery diameter （LPAD）, right low pulmonary artery diameter （RLPAD）, ascending aorta diameter （AAD） and descending aorta diameter （ DAD）, and parameters were calculated including the ratio of the main pulmonary and ascending aorta diameter （rPA） ,the ratio of the ascending and descending aorta diameter （rAD）, the ratio of the right ventrieular and left ventricular short axis diameter （RV/LV）. The relationship between sex, pulmonary, lymph nodes, pericardium, pleural and pulmonary arrery pressure （PAP） was analyzed by Spearman rank correlation analysis. All the parameters between mild-moderate （4 cases） and severe （16 cases） PAH were analyzed by independent sample t test. PAP of different age （ 〈 50 years and ≥ 50 years） groups was analyzed by Pearson correlation analysis. Results Of 20 cases,7 cases showed patch exudative change, 5 cases showed ＂mosaic pattern＂ inhomogeneous perfusion, 3 cases displayed ill-defined centrilobular nodules, 6 cases manifested mediastinal lymphadenopathy, 10 cases had pericardial effusion including 4 cases of pleural effusion, 4 cases of dilated bronchial artery, 1 cases of secondary right pulmonary artery embolism. When comparing the presence or absence of pleural effusion, these was statistical difference of PAP （
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第3期172-176,共5页
National Medical Journal of China
关键词
体层摄影术
X线计算机
高血压
肺性
诊断技术
心血管
Tomography, X-ray computed
Hypertension, pulmonary
Diagnostic techniques, cardiovascular
