CAT评分及胸部CT血管测量在慢阻肺相关肺动脉高压预测中的价值分析

Predictive value of CAT scale and chest CT vascular measurement in COPD-related pulmonary hypertension

目的了解CAT评分、主肺动脉直径(MPAD)、主肺动脉/升主动脉直径比(rPA)、主肺动脉/降主动脉直径比(rPD)与慢阻肺相关肺动脉高压的相关性,分析其对慢阻肺相关肺动脉高压的预测价值。方法收集我科慢阻肺患者174例,根据心脏彩超结果分为肺动脉压力正常组、轻度增高组、中-重度增高组,分析三组间一般资料,比较三组间CAT评分、MPAD、rPA、rPD的差异性,分析其与肺动脉压力的相关性。采用ROC曲线分析CAT评分、MPAD、rPA、rPD预测慢阻肺相关肺动脉高压的阈值。结果轻度增高组的CAT评分、MPAD、rPD均高于正常组(P<0.05),rPA比较无差异(P>0.05);中-重度增高组的CAT评分、MPAD、rPA、rPD均高于正常组及轻度增高组(P<0.05)。CAT评分、MPAD、rPA、rPD与肺动脉压力均成正相关(P<0.01)。CAT评分、MPAD、rPA、rPD预测慢阻肺相关轻度肺动脉高压的阈值分别为21分、33.5 mm、0.95、1.12;预测慢阻肺相关中-重度肺动脉高压的阈值分别为28分、35.5 mm、1.02、1.20。CAT评分分别联合MPAD、rPA、rPD预测慢阻肺相关轻度肺动脉高压可兼顾灵敏度与特异度,预测中-重度肺动脉高压的灵敏度与特异度均较单一指标高。结论 CAT评分、MPAD、rPA、rPD与慢阻肺患者的肺动脉压力成正相关性,当CAT评分>21分、MPAD>33.5 mm、rPA>0.95、rPD>1.12提示慢阻肺并发轻度肺动脉高压,当CAT评分>28分、MPAD>35.5 mm、rPA>1.02、rPD>1.20提示慢阻肺并发中-重度肺动脉高压。CAT评分联合胸部CT血管测量预测慢阻肺相关肺动脉高压较单一指标好。

Objective To investigate the correlation of CAT scale, main pulmonary artery diameter （MPAD） , the ratio of main pulmonary artery diameter to ascending artery （rPA）, and the ratio of main pulmonary artery artery diameter to descending artery （rPD） with COPD-ralated pulmonary hypertension, and to analyze the pre- diction of them to COPD-ralated pulmonary hypertension. Methods 174 COPD patients were selected in this study, and they were divided into the normal pulmonary tension group, the mild group, and the moderate to severe group according to the results of eehocardiography. Their general information was analyzed, and the difference of CAT scale, MPAD, rPA and rPD was compared among the three groups. Their correlations to pulmonary hypertension were also analyzed. It used ROC curve to analyze the prediction value of CAT scale, MPAD, rPA and rPD to the threshold of COPD-ralated pulmonary hypertension. Results The level of CAT scale, MPAD, rPA and rPD were higher in the mild group than in the normal group （P 〈 0. 05）, and there was no difference in rPA between the two groups （ P 〉 0. 05 ）. The level of CAT scale, MPAD, rPA and rPD was higher in the moderate to severe group than in the normal group and the mild group （ P 〈 0. 05 ）. Correlation analysis showed that CAT scale, MPAD, rPA and rPD were posi- tively associated with pulmonary hypertension （P 〈 0. 01 ）. The prediction value of CAT scale, MPAD, rPA and rPD to the threshold of COPD-related mild pulmonary hypertension were 21 points, 33.5 mm, 0. 95 and 1.12. The pre- diction value of CAT scale, MPAD, rPA and rPD to the threshold of COPD-related moderate to severe pulmonary hy- pertension were 28 points, 35.5 mm, 1.02 and 1.20. CAT scale combined with MPAD, rPA and rPD could improve sensitivity and specificity in the prediction of COPD-related moderate to severe pulmonary hypertension. Conclusion CAT scale, MPAD, rPA and rPD are positively correlated with COPD-related pulmonary hypertension. While CAT scale 〉 21 points, MPAD 〉 33.5 mm, rPA 〉 0. 95, and rPD 〉 1.12, it suggests that COPD patients complicate with mild pulmonary hypertension. While CAT scale 〉 28 points, MPAD 〉 35.5 mm, rPA 〉 1.02, rPD 〉 1.20, it sug- gests that COPD patients complicate with moderate to severe pulmonary hypertension. The combination of CAT scale and chest CT vascular measurement to predict COPD-related pulmonary hypertension is better than single index does.