胸部CT对COPD合并肺动脉高压分级诊断价值

Diagnostic Value of Chest CT for COPD with the Classification of Pulmonary Arterial Hypertension

目的:结合多普勒超声心动图对比分析胸部CT平扫在慢性阻塞性肺病(COPD)合并肺动脉高压(PAH)分级上的诊断价值。方法:回顾性分析100例经多普勒超声心动图检查确诊、分级的COPD合并PAH患者的胸部CT平扫资料,测量CT所示的主肺动脉直径、右肺动脉直径及左肺动脉直径,并与30例未发生PAH的COPD患者的上述胸部CT平扫资料对比,分析它们与PAH分级的关系,并进行统计学分析。结果:100例COPD并PAH患者中,经超声心动图确诊为轻度PAH 57人,中度PAH 27例,重度PAH 16例。上述三组PAH患者CT上所测量的主肺动脉直径,方差分析得出三者间的差别有统计学意义,两两比较发现:轻度组PAH的主肺动脉直径与中度组PAH的主肺动脉直径有统计学差异(P=0.017);轻度组PAH的主肺动脉直径与重度组PAH的主肺动脉直径有统计学差异(P=0.000);中度组PAH的主肺动脉直径与重度组PAH的主肺动脉直径有统计学差异(P=0.031);轻度组PAH的主肺动脉直径<中度组PAH的主肺动脉直径<重度组PAH的主肺动脉直径。轻度PAH的主肺动脉直径约为29.71 mm±3.57 mm,最佳诊断阈值是29.11 mm;中度PAH的主肺动脉直径约为31.77 mm±3.44 mm,最佳诊断阈值是30.53 mm;重度PAH的主肺动脉直径约为34.28 mm±4.14 mm,最佳诊断阈值是32.00 mm。结论:胸部CT平扫通过测量主肺动脉直径对COPD并PAH的分级具有一定的诊断价值。

Objective： Combining Doppler echocardiography, the comparison analysis of chest CT in the classification of pulmonary arterial hypertension （PAH） in chronic obstructive pulmonary diseases （COPD）. Methods： Retrospective analysis of 100 diagnosed cases whose chest CT scan＇s materials by Doppler echocardiography with classification of PAH in COPD, measuring the main pulmonary artery diameter （MPAD）, the right pulmonary artery diameter （RPAD） and the left pulmonary artery diameter （LPAD） which are showed on the chest CT, comparing with the above chest CT scan data of 30 cases of COPD patients without PAH, to analyze their relationaships with the classification of pulmonary arterial hypertension and to do some statistical analysis. Results： Among 100 cases of PAH, 57 patients were diagnosed as mild PAH, 27 patients were diagnosed as moderate PAH, 16 patients were diagnosed as severe PAH by Doppler echocardiography. According to three groups patients of PAH above, the MPAD which were measured in the computed tomography can be obtained by analysis of variance among the three statistically significant differences. Drawing a parallel between the two, we can find that, there are some statistical differences between the MPAD of mild PAH and moderate PAH （P= 0.017）. There are statistical differences between the MPAD of mild PAH group and severe PAIl group （P = 0.000）. There are also statistical differences between the MPAD of moderate PAH group and severe PAH group （P= 0.031）, and the data of MPAD in the mild PAH group 〈 the moderate PAH group 〈 the severe PAHgroup. The data of mild PAH group＇s MPAD is （29.71±3.57） mm, and the best diagnostic threshold is 29.11 mm; The data of moderate PAH group＇s MPAD is （31.77 ± 3.44） mm, and the best diagnostic threshold is 30.53 ram; the data of severe PAH group＇s MPAD is （34.28±4.14） ram, and the best diagnostic threshold is 32.00mm. Conclusion： There is some diagnostic value in the classification of PAH in COPD through measuring MPAD by chest computed tomography scanning.