摘要
目的探讨超声心动图指标与CT肺动脉栓塞指数(PAOI)在急性肺栓塞的相关性。方法选择2015年10月至2019年10月在温州医科大学附属第一医院行计算机断层肺动脉造影(CTPA)检测的患者144例,根据是否确诊急性肺栓塞,分为栓塞组71例,非栓塞组73例。比较两组超声心动图指标,包括肺动脉收缩压(PASP)、主肺动脉内径(MPAD)、主动脉根部内径(AORD)、右心房增大者比例、左心房内径(LAD)、左心室舒张末期内径(LVDD)、左心室舒张末期容量(LVEDV)、左心室收缩末期内径(LVSD)、左心室收缩末期容量(LVESV)、每搏量(SV)、左心室射血分数(LVEF)。PAOI采用Mastora评分方法。分析超声心动图指标与PAOI之间的相关性。根据PAOI(<30%、30%~50%、>50%)将栓塞组患者分为轻、中、重度3亚组,对3亚组患者的PASP值进行两两比较。采用ROC曲线分析PASP诊断急性肺栓塞的效能,得出最佳临界值。结果栓塞组右心房增大者比例、PASP、MPAD[27(38.0%)、47.0(36.0,57.0)mmHg、25.0(22.0,28.0)mm]均高于非栓塞组[0(0%)、33.0(29.5,37.0)mmHg、24.0(22.0,25.0)mm],差异均有统计学意义(均P<0.05),栓塞组LAD、LVDD、LVEDV、SV[(37.5±5.2)mm、45.0(43.0,49.0)mm、92.4(83.1,112.8)ml、60.2(53.5,68.7)ml]均低于非栓塞组[(39.7±5.5)mm、48.0(45.0,51.0)mm、107.5(92.4,123.8)ml、71.8(59.4,79.7)ml],差异均有统计学意义(均P<0.05);栓塞组与非栓塞组AORD、LVSD、LVESV、LVEF[(35.8±3.7)vs(35.8±3.7)mm、29.0(27.0,33.0)vs 31.0(29.0,33.0)mm、32.2(27.0,44.1)vs 37.9(32.2,44.1)ml、64.9(61.6,67.4)vs 65.2(62.7,68.0)%]差异均无统计学意义(均P>0.05)。栓塞组中PAOI[27.3(14.2,38.7)%]与PASP呈正相关(r=0.439,P<0.01),与LVDD、LVEDV、SV均呈负相关(r=-0.334、-0.334、-0.327,均P<0.05),与LAD及MPAD均无相关性(r=-0.106、0.202,均P>0.05)。栓塞组中PAOI轻度亚组患者的PASP值低于PAOI重度亚组,差异有统计学意义[45.9(30.0,54.5)mmHg比(63.3±3.2)mmHg],调整后P=0.033,PAOI轻度与中度亚组[45
Objective To explore the correlation between echocardiography and CT pulmonary embolism index in acute pulmonary embolism.Methods A total of 144 patients who underwent CT pulmonary angiography(CTPA)in the First Affiliated Hospital of Wenzhou Medical University from October 2015 to October 2019 were enrolled.There were 71 cases of acute pulmonary embolism(APE group)and 73 cases of non-acute pulmonary embolism(NPE group).The results of echocardio-graphy were compared between the two groups,including pulmonary artery systolic pressure(PASP),aortic root diameter(AORD),right atrium enlargement,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVDD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic diameter(LVSD),left ventricular end-systolic volume(LVESV),stroke volume(SV),left ventricular ejection fraction(LVEF),the main pulmonary artery diameter(MPAD).Mastora score was used for CT pulmonary embolism index(PAOI).The correlation between echocardiographic parameters and PAOI was analyzed.According to PAOI(<30%,30%~50%,>50%),patients in APE group were divided into three subgroups:light,medium,and severe,and pair-to-pair comparison was conducted on PASP values of patients in the three subgroups.The receiver operating characteristic curve(ROC)was used to analyze the efficacy of PASP in diagnosing APE,and the optimal threshold was obtained.Results Compared with NPE group,APE group showed higher percentage of right atrium enlargement,PASP,MPAD[27(38.0%),47.0(36.0,57.0)mmHg,25.0(22.0,28.0)mm]than NPE group[0(0%),33.0(29.5,37.0)mmHg,24.0(22.0,25.0)mm](χ^2/t/Z=34.17,-6.336 and 2.24,all P<0.05).In the APE group,LAD,LVDD,LVEDV and SV[(37.5±5.2)mm,45.0(43.0,49.0)mm,92.4(83.1,112.8)ml,60.2(53.5,68.7)ml]were all lower than those in the NPE group[(39.7±5.5)mm,48.0(45.0,51.0)mm,107.5(92.4,123.8)ml,71.8(59.4,79.7)ml](t/Z=2.513,-3.052,3.04 and 3.69,all P<0.05).There were significant differences in AORD,LVSD,LVESV,AND LVEF[(35.8±3.7)vs(35.8±3.7)mm,29.0(27.0,33.0)vs 31.0(29.0,33.0)mm,32.2(27.
作者
蔡飞飞
叶燃
陈斌
CAI Feifei;YE Ran;CHEN Bin(Department of Ultrasonography,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)
出处
《浙江医学》
CAS
2020年第16期1733-1737,1741,共6页
Zhejiang Medical Journal
关键词
肺栓塞
肺动脉高压
超声心动图
左心室
Pulmonary embolism
Pulmonary arterial hypertension
Echocardiography
Left ventricle
