256层螺旋CT肺动脉造影对肺动脉栓塞患者右心功能的评价

Evaluation of right heart function in patients with acute pulmonary embolism by 256-slice spiral pulmonary artery angiography

目的：探讨256层螺旋CT肺动脉造影（CTPA）对急性肺栓塞（APE）患者右心功能评价的价值。方法：根据APE患者的死亡风险评估,76例APE患者被分为高危APE组（41例）和非高危APE组（35例）。在CTPA图像上,分析两组患者CT阻塞指数及右心功能参数的差异,并分析CT阻塞指数与右心功能参数的相关性。结果：与非高危APE组比较,高危APE组CT阻塞指数[8.58%比24.69%]、室间隔平直或左突（31.43%比73.17%）、支气管动脉扩张比例（5.71%比24.39%）显著升高,除上腔静脉直径外,两组其余右心功能参数比较,差异均有统计学意义,P〈0.05或〈0.01。Spearman相关分析显示CT阻塞指数与右室短轴最大径（RVMSA）、RV∶LV,主肺动脉直径,上腔静脉直径,奇静脉直径呈显著正相关（r=0.684-0.954）,与LVMSA呈显著负相关（r=-0.786）,P均〈0.01。ROC曲线分析显示,RV∶LV诊断APE严重程度的AUC最大（0.949）。结论：多层螺旋CT右心功能参数是评价APE严重程度的准确而实用的参数,具有重要的应用价值。

Objective：To explore value of 256-slice spiral CT pulmonary artery angiography（CTPA）evaluating right heart function in patients with acute pulmonary embolism（APE）.Methods：According to death risk assessment of APE patients,a total of 67 APE patients were divided into high risk APE group（n=41）and non-high risk APE group（n=35）.CTPA was used to analyze and compare CTPA obstructive index and right heart function indexes between two groups.Correlations among CTPA obstructive index and right heart function indexes were also analyzed.Results：Compared with non-high risk APE group,there were significant rise in CTPA constructive index[8.58% vs.24.69%],percentages of straight or left protruded ventricular septum（31.46% vs.73.17%）and bronchial artery dilation（5.71% vs.24.69%）;Except the superior vena cava diameter,the rest right heart function parameters had difference significance in two groups,P〈0.05or0.01.Spearman correlation analysis indicated that CTPA obstructive index was significant positively correlated with right ventricular maximal short axis（RVMSA）,RV∶LV,diameters of main pulmonary artery,superior vena cava and azygos（r=0.684-0.954）,and significant inversely correlated with LVMSA（r=-0.786）,P〈0.01 all.ROC curve analysis indicated that AUCs of CTPA RV∶LV（0.949）was the biggest diagnosing APE severity.Conclusion：Right heart function indexes measured by multi-detector CT are accurate and practical indexes evaluating APE severity,and it possesses important significance.