急性肺动脉栓塞的CTPA诊断与临床特点相关性研究

Correlative study between CTPA and its clinical features of acute pulmonary embolism

目的:探讨急性肺动脉栓塞(APE)特征性临床特点及CT肺动脉成像(CTPA)表现。方法:378例疑似APE的患者行CTPA检查,66例确诊为APE,312例无PE。对APE患者的CTPA表现进行分析,并与同期无PE患者的临床表现、实验室指标及CTPA表现进行对比。结果:66例APE患者的CTPA直接征象为充盈缺损。右肺动脉亚段以上栓塞灶185个,左肺动脉亚段以上栓塞灶121个,二者差异具有统计学意义(χ2=3.86,P=0.05)。APE临床表现如胸痛或胸闷、活动后气喘或气促、长期卧床、冠心病或房颤、深静脉血栓、D-二聚体升高、动脉氧分压等,与同期无PE组比较,差异均具有统计学意义(P<0.05)。APE组血浆D-二聚体水平与肺动脉栓塞灶总数呈正相关(r=0.26,P=0.03)。动脉氧分压与肺动脉栓塞灶总数无明显相关性(r=-0.12,P=0.35)。结论:充盈缺损是APE患者的CTPA直接征象。临床症状疑似的APE塞者,CTPA应为首选检查手段。

Objective：To investigate the clinical characteristics and CT pulmonary angiography（CTPA）features of acute pulmonary embolism（APE）.Methods：378patients suspected of pulmonary embolism（PE）underwent dual-source CTPA.66 patients were diagnosed with APE and PE while the rest 312 patients were excluded as negative.The images of CTPA were evaluated and the clinical,laboratory and CTPA data between APE and non-PE patients were analyzed comparatively.Results：The direct sign in CTPA of 66 patients with APE was filling defects.There were 185 embolic lesions in the right segmental or subsegmental pulmonary arteries,and 121 in the left segmental or subsegmental pulmonary arteries.There were significant differences between both sides（χ2=3.86,P=0.05）.The clinical data such as nonspecific chest pain or chest tightness,wheezing or asthma after exercise,bedridden,coronary disease or atrial fibrillation,deep vein thrombosis（DVT）,and increased D-dimer all showed significant differences between APE and non-PE patients.There was positive correlation（r=0.26,P=0.03）between the amount of embolic lesions with plasma D-dimer level,however,there was no correlation（r=-0.12,P=0.35）with the level of arterial PaO2 in APE patients.Conclusion：Filling defects were the typical CTPA findings of APE.For the patients suspected of PE clinically,CTPA can be the first option as imaging diagnostic method.