CT肺动脉造影预测急性骑跨型肺动脉栓塞的早期病死率

Prediction for short term mortality of acute saddle pulmonary embolism according to CT pulmonary angiography findings

目的:探讨多层螺旋计算机体层成像肺动脉造影(CTPA)能否预测急性骑跨型肺动脉栓塞1个月的早期病死率。方法:搜集经CTPA确诊为急性骑跨型肺栓塞的患者115例,根据1个月内的预后情况,分为死亡组和非死亡组,测量并计算CTPA中右房横径/左房横径比值(RAd/LAd)、右室面积/左室面积比值(RVa/LVa)、脊柱室间隔夹角(Cobb角)及Mastora肺栓塞指数,上述参数值采用Mann-Whitney U检验和受试者工作特征(ROC)曲线进行统计学分析。结果:死亡组中RAd/LAd比值(P=0.001)、RVa/LVa比值(P=0.006)、Cobb角(P=0.001)及Mastora栓塞指数(P=0.001)均明显高于非死亡组。ROC曲线显示RAd/LAd比值(Z=4.241,P<0.0001)、RVa/LVa比值(Z=6.670,P<0.0001)、Cobb角(Z=4.711,P<0.0001)及Mastora肺栓塞指数(Z=3.948,P=0.0001)等4个参数预测骑跨型肺动脉栓塞早期病死率的截断点数值分别为2.2、2.0、58°和69%。结论:RAd/LAd比值、RVa/LVa比值、Cobb角及Mastora肺栓塞指数,尤其是RVa/LVa和Cobb角,可能有助于预测急性骑跨型肺动脉栓塞的早期病死率。

Objective：To study whether CT pulmonary angiography （CTPA） findings could predict 1 month mortality in patients with acute saddle pulmonary embolism （PE）. Methods： 115 patients with acute saddle PE diagnosed by CTPA were recruited. According to the prognosis within one month, these patients were divided into survival group and diseased group. The ratio of right atrial transverse dimension and left atrial transverse dimension （RAd/LAd） ,ratio of right ventricular area and left ventricular area （RVa/LVa）, angle between vertebrae and inter-ventricular septum （Cobb angle） displayed on CTPA, and Mastora score of PE were measured and calculated. The results were statistically analyzed by Mann Whitney U Test and receiver operating characteristic （ROC） curve. Results： Of the diseased group, the RAd/LAd, RVa/LVa, Cobb angle and Mastora score were significantly higher than that of survival group （P： 0. 001,0. 006,0. 001 and 0. 001, respectively）. According to areas under ROC curves,using RAd/Lad （Z=4.24,P〈0. 001）,RVa/LVa （Z=6.67,P〈0. 001）, Cobb angle （Z=4.71 ,P〈0. 001） and Mastora score （Z=3.95 ,P〈0. 001） as the parameter to predict short term mortality of acute saddle PE, the cut off value was 2.2,2.0,58°and 69%, respectively. Conclusion： RAd/LAd, RVa/LVa, Cobb angle and Mastora score,especially RVA/LVA and Cobb angle, might be helpful in predicting short term mortality of patients with acute saddle PE.