胸部CT扫描测定肺动脉与主动脉直径比值在慢性阻塞性肺疾病预后中的价值

A one-year follow-up on prognosis of chronic obstructive pulmonary disease by CT scan-measured pulmonary artery to aorta ratio

目的研究动态测定肺动脉与主动脉(PA:A)比值对慢性阻塞性肺疾病(COPD)患者预后判断的临床意义。方法本研究共入选2014年10月~2015年10月上海市浦东新区公利医院呼吸内科病房收治的慢性阻塞性肺疾病急性加重(AECOPD)患者90例,根据胸部CT扫描测定的PA:A比值分组,PA:A比值≤1的患者分为A组(45例),PA:A比值>1的患者分为B组(45例),分别测定两组患者入院时、出院时、出院后6个月、出院后12个月的临床资料,同时行超声心动图检查、记录CAT评分,测定肺功能、6 min步行距离(6MWT)、动脉血气,留取血液测定血常规、血CRP、NT-pro BNP水平,记录12个月内急性加重次数及死亡患者数目。结果 B组患者1年内急性加重次数高于A组,差异有统计学意义(P<0.05);B组患者1年内死亡率高于A组,差异有统计学意义(P<0.05)。入组时,两组患者的PA:A比值、NT-pro BNP、肺动脉收缩压(PASP)比较,差异有统计学意义(P<0.05),B组明显高于A组,而PH值、Pa O_2、Pa CO_2、血WBC、血hs-CRP、第一秒用力呼气量占预计值百分比(FEV1%)、6MWT、CAT问卷评分比较,差异无统计学意义(P>0.05);随访1年后,两组患者的PA:A比值、NT-pro BNP、PASP、FEV1%、PH值、Pa O_2、Pa CO_2、6MWT、CAT问卷评分比较,差异有统计学意义(P<0.05),而血WBC、血hs-CRP差异仍无统计学意义(P>0.05)。两组患者的PA:A比值与Pa CO_2、NT-pro BNP、PASP、CAT评分呈正相关(P<0.05),与Pa O_2、6MWT、FEV1%呈负相关(P<0.05),且B组患者的相关性大于A组。结论胸部CT扫描测定PA:A比值可以作为判断COPD患者预后的一项重要指标。

Objective To study the clinical significance of the dynamic ratio of pulmonary artery to aorta （PA：A） in predicting the prognosis of patients with chronic obstructive pulmonary disease （COPD）. Methods 90 patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） admitted to the respiratory department, Gongli Hospital,Pudong new area,Shanghai,China,from October 2014 to October 2015 were enrolled. The PA： A ratio was stratified according to the chest CT scan. Patients with PA：A ratio≤1 were divided into group A（n=45） and patients with PA： A〉 1 were divided into group B （n=45）.The clinical data of the two groups were measured .at admission, at discharge, 6 months after discharge, and 12 months after discharge.Echocardiography was performed and CAT scores were recorded at the same time.Pulmonary function, 6-minute walking distance （6MWT）,arterial blood gas analysis were recorded in the two groups.NT-proBNP were measured by routine blood test.The number of acute exacerbations and deaths were recorded within 12 months. Results The times of acute exacerbation in group B were higher than that： in group A （P 〈 0.05）.The mortality rate in：group B was significantly higher than that in group A within 1 year.There were significant differences in the PA：A ratio,NT-proBNP and PASP between the two groups（P 〈 0.05）,while the B group was significantly higher than the A group. There were no significant differences in PH,PaO2,PaCO2,WBC,hs-CRP,FEV,%, 6MWT and CAT scores （P 〉 0.05）.After a year of follow-up, there were significant differences in PA：A ratio,NT-proB- NP,PASP,FEV1%,PH,PaO2,PaCO2,6MWT and CAT scores between the two groups （P 〈 0.05）.There was a positive correlation between PA：A ratio,PaCO2, NT-proBNP, PASP and CAT scores （P 〈0.05）,and negatively correlated with PaO2, 6MWT and FEV1%（P 〈 0.05）.Group B is higher than group A. Conclusion CT scan-measured PA：A ratio can be used as an important index to predict the prognosis of patients with COPD.