慢性血栓栓塞性肺动脉高压CTPA测定脊柱室间隔角与右室功能、氨基末端脑钠肽前体的关系

Relationship between spinal ventricular septal angle by computer tomographic pulmonary angiography and right cardiac functions, N-terminal brain natriuretic peptide in chronic thromboemboHc pulmonary hypertension

目的分析慢性血栓栓塞性肺动脉高压（CTEPH）脊柱室间隔角与右室功能参数及氨基末端脑钠肽前体（NT—proBNP）的关系，探讨脊柱室间隔角评价CTEPH的意义和价值。方法回顾性分析2008年1月至2010年1月确诊CTEPH患者44例，男26例、女18例，年龄27～84岁，平均年龄（52±12）岁，同时选择最终临床诊断无肺动脉高压及肺栓塞，且年龄、性别匹配44例为对照组。多层螺旋计算机断层扫描肺动脉造影（CTPA）图像上测定脊柱室间隔夹角。超声测定右心功能参数，酶联免疫吸附试验（ELISA）法测定NT—proBNP水平。结果CTEPH患者脊柱室间隔角为（63±11）°，对照组脊柱室间隔夹角为（40±7）°，差异有统计学意义（t=12．320，P=0．000）。44例CTEPH患者的脊柱室间隔夹角与NT-proBNP呈正相关（r=0．704，P=0．000）；与超声测定右房横径（r=0．381，P=0．002），右房长径（r=0．437，P=0．000），右室横径（r=0．449，P=0．000）均呈正相关。与右心导管测定心排出量（r=-0．337，P=0．025）、心指数（r=-0．351，P=0．020），右心做功量（r=-0．307，P=0．043），右心室心搏做功指数（r=-0．384，P=0．010）均呈负相关。结论脊柱室间隔角能够反映CTEPH患者NT-proBNP及右心功能变化，在评价CTPEH时可能具有重要的参考价值。

Objective To explore the relationship of spinal ventricular septal angle （SVSA） measured by computer tomographic pulmonary angiography （CTPA） and right cardiac functions, N-terminal brain natriuretic peptide （NT-proBNP）in the patients with chronic thromboembolic pulmonary hypertension （CTEPH）. Methods Forty-four CTEPH patients, 26 males and 18 females aged （52 ± 12） years old on average, at our hospital from January 2008 to January 2010 were retrospectively reviewed. SVSA and such pulmonary artery obstruction indices as Qanadli and Mastora indices were evaluated by two independent radiologists. The parameters of right heart functions were evaluated by echocardiography and right-heart catheterization. The level of NT-proBNP was measured by enzyme linked immunosorbent assay （ELISA）. Results SVSA was （63 - 11 ） o in CTEPH and （40 ± 7 ） ° in the control group. The differences were significant（ t = 12. 320, P = 0. 000）. SVSA had a moderately positive correlation with the level of NT- proBNP （ r = 0. 704, P = 0. 000 ）. A positive correlation existed between SVSA and right atrium transverse diameter （ r = 0. 381, P = 0. 002 ）, right atrium long axis diameter （ r = 0. 437, P = 0. 000 ） and right ventricular transverse diameter （ r = 0. 449, P = 0. 000 ） on echocardiography. But there was no correlation between SVSA and right ventricular ejection fraction （ r = - 0. 175, P = 0. 365, n = 24）. Also there was a negative correlation between SVSA and cardiac output （ r = - 0. 337, P = 0. 025 ） , cardiac index （ r = -0. 351 , P =0. 020） , right cardiac work （r = -0. 307, P =0. 043） and right ventrieular stroke work （r = -0. 384, P = 0. 010）. Conclusion Spinal ventfieular septal angle measured on CTPA may serve as a better predictor for evaluating the level of NT-proBNP and right cardiac functions in CTEPH.