慢性阻塞性肺疾病相关肺动脉高压的多层螺旋CT评价

Evaluation of pulmonary arterial hypertension in chronic obstructive pulmonary disease by multislicespiral CT

目的探讨多层螺旋CT（MSCT）对COPD相关肺动脉高压的诊断价值。方法纳入2011年1至11月在兰州大学第一医院行健康检查及就诊的100名健康成人及81例COPD患者，分别测量其肺动脉直径及面积，计算主肺动脉与升主动脉、降主动脉、胸椎及气管直径的比值，分析其与COPD相关肺动脉高压的关系，两样本均数比较采用t检验，多组均数比较使用单因素方差分析，两两比较使用SNK法，多样本率比较采用）（。检验。结果COPD组各项MSCT观察指标与对照组相匹配，分别按照年龄、病情严重程度及肺动脉收缩压将COPD患者细分为〈40岁组、40～60岁组和〉60岁组，I级组、Ⅱ级组、Ⅲ级组和Ⅳ级组，肺动脉压〉50mmHg（1mmHg：0．133kPa）组和≤50nlnlHg组，各亚组MSCT观察指标分别与对照组比较，差异均有统计学意义（均P〈0．05）；COPD组主肺动脉直径[（3．14±0．63）cm]等与肺动脉收缩压呈正相关（均P〈0．05），主肺动脉直径与气管横径比值（1．81±0．48）等与FEV．占预计值％呈负相关（P〈0．05），各观察指标敏感度差异无统计学意义（X2=17．76，P〉0．05）。结论MSCT在COPD相关肺动脉高压的诊断有着不可替代的优势，主肺动脉直径与气管横径的比值、主肺动脉横断面面积、主肺动脉直径与胸椎横径的比值可与既往指标一起作为诊断标准评价COPD相关肺动脉高压。

Objective To investigate the use of multislice spiral CT （MSCT） in the diagnosis of pulmonary arterial hypertension （PAH） in patients with chronic obstructive pulmonary disease （COPD）. Methods The diameters and areas of the pulmonary artery were measured in 81 cases with COPD and 100 normal adults from January to November 2011. The ratios of the diameters of the main pulmonary artery （MPA） to ascending aorta （ AA ） , descending aorta （ DA ） , trachea, thoracic vertebra （ ThV ） were also calculated. Data analysis used the t test of the 2 samples compared, multi-rate compared by X2 test. Results There were significant differences in the measured parameters between the COPD group and the control group. The differences were also significant among groups of COPD patients aged 〈 40 y, 40 - 60 y, 〉 60 y, and the control group, among patients with different stages of COPD （ stage Ⅰ , Ⅱ ,Ⅲ, Ⅳ ） and the control group, and among patients with sPAP 〉 50 mm Hg （ 1 mm Hg = 0. 133 kPa） , sPAP≤50 mm Hg and the control group. There were positive correlations between sPAP and the measured indexes such as MPA [ （3. 14±0. 63）cm] of pulmonary artery in COPD. There were negative correlations between FEV1% and some of the measured indexes such as MPA/T1（ 1.81 ±0. 48 ）. Multi-indicators was no significant difference （X2 = 17. 76 ,P 〉 0. 05 ）. Conclusions MSCT is veldt useful in diagnosis of PAH in COPD. The diameter ratio of MPA to trachea, the area of MPA, and the diameter ratio of MPA to ThV can be used as diagnostic criteria for evaluation of PAH in COPD.