胸部CT测定肺动脉直径与主动脉直径比值判断慢性阻塞性肺疾病急性加重的临床价值

Clinical value of the ratio of pulmonary artery diameter to aorta diameter on chest computed tomography for the assessment of acute exacerbation of chronic obstructive pulmonary diseases

目的研究胸部CT测定肺动脉直径与主动脉直径比值(PA∶A比值)判断慢性阻塞性肺疾病急性加重(AECOPD)的临床价值。方法选择上海市浦东新区公利医院呼吸内科病房2012年11月-2014年10月间收治的118例AECOPD患者,根据PA∶A比值将其分为PA∶A比值≤1组(比值≤1组,53例)和PA∶A比值>1组(比值>1组,65例),比较两组患者入院时(治疗前)与入院后10d(治疗后)的血常规、血超敏CRP(血hs-CRP)、动脉血气分析、肺功能、慢性阻塞性肺疾病(COPD)评估测试(CAT)问卷评分、胸部CT、心脏彩色超声检查结果,分析PA∶A比值与其他指标的相关性。结果治疗前,比值>1组的PA∶A比值、肺动脉收缩压(PASP)、动脉血二氧化碳分压(paCO2)、血hs-CRP、CAT问卷评分均显著高于比值≤1组(P值均<0.05),1秒钟用力呼气量占预计值的百分比(FEV1%)、动脉血pH值、动脉血氧分压(paO2)均显著低于比值≤1组(P值均<0.05),两组间血白细胞计数的差异无统计学意义(P>0.05);治疗后,比值>1组的FEV1%显著低于比值≤1组(P<0.05),两组间其他指标的差异均无统计学意义(P值均>0.05)。两组患者治疗后的FEV1%、动脉血pH值、paO2均显著高于同组治疗前(P值均<0.05),治疗后的PA∶A比值、PASP、paCO2、血白细胞计数、血hs-CRP水平、CAT问卷评分均显著低于同组治疗前(P值均<0.05)。两组患者治疗前后的PA∶A比值与PASP、paCO2、血白细胞计数、血hs-CRP水平、CAT问卷评分均呈正相关(P值均<0.05),与FEV1%、动脉血pH值、paO2均呈负相关(P值均<0.05)。结论胸部CT测定PA∶A比值有助于判断AECOPD和病情严重程度。

Objective To study the clinical value of the ratio of pulmonary artery diameter to aorta diameter （PA/A） on chest computed tomography （CT） for the acute exacerbation of chronic obstructive pulmonary diseases （AECOPD）. Methods A total of 118 AECOPD hospitalized patients treated in the Gongli Hospital of Pudong New Area in Shanghai from November 2012 to October 2014 were enrolled in this study. The subjects were divided into two groups： group A （PA/A≤1, n =53） and group B （PA/A〉 1, n =65）. Blood routine examination, serum high -sensitivity C-reactive protein（hs-ORP） measurement, arterial blood gas analysis, lung function test, chronic obstructive pulmonary diseases assessment test （CAT） questionnaire, chest CT and echocardiography were performed at the admission and 10 days after the admission. The correlation between PA/A and other parameters were assessed. Results At the admission, PA/A, pulmonary artery systolic pressure （PASP）, arterial partial pressure of carbon dioxide （paCO2）, hs-ORP and CAT score in group B were significantly higher than those in group A （all P〈0. 05）; the ratio of forced expiratory volume in a second to predicted volume（FEV1 %）, potential of hydrogen value of arterial blood, arterial partial pressure of oxygen （paO2） in group B were significantly lower than those in group A （all P〈0.05） ; there was no statistical difference in the total blood white blood cell count between groups （P〉0.05）. Compared with those at the admission, FEV1 %, pH value of arterial blood and paO2 were significantly increased, while PA/A, PASP, paCO2, white blood cell count, hs-ORP and CAT scores were significantly decreased after admission in both groups （all P〈0.05）. PA/A was positively correlated with the PASP, paCO2, white blood cell count, hs-ORP and CAT score, and negatively correlated with the FEV1 %, pH value of arterial blood and paO2 in two groups before and after treatment （all P〈0. 05）. Conclusion The PA/A ratio on chest CT is contributable to judge the diagnosis and severity of AECOPD.