不同类型急性肺栓塞临床相关因素分析及胸部继发改变的CT肺动脉成像特征

Clinical correlative factors and CT pulmonary angiography characteristics of secondary changes of chest in different types of acute pulmonary embolism

目的 探讨不同类型急性肺栓塞的临床相关因素及胸部继发性改变的CT肺动脉成像（CTPA）特征.方法 回顾性分析2015年1月至2016年10月经CTPA确诊为急性肺栓塞的连续患者152例,按照栓塞部位将其分为中央型和周围型,分别记录两组的临床特点（包括性别、年龄、危险分层等）、实验室检查（包括D-二聚体等）以及继发的影像表现（包括肺动脉干增粗及右心增大等）.采用独立样本t检验（正态分布）或Mann-Whitney U检验（偏态分布）对中央型和周围型患者年龄、体重指数、住院时间及实验室检查各参数值进行比较,采用χ^2=验及Fisher确切概率法对性别、吸烟史等临床特点及继发影像表现等指标进行比较.结果152例急性肺栓塞患者中,中央型70例,周围型82例.中央型高、中、低危患者分别为7、33、30例,周围型分别为2、16、64例,中央型中、高危患者比例高于周围型,危险分层在两组间的差异有统计学意义（P〈0.001）.在临床治疗方式的选择上,中央型与周围型选择溶栓治疗的例数分别为5、0例,差异有统计学意义（P=0.019）;其余如性别、年龄等临床特点差异均无统计学意义（P值均〉0.05）.中央型与周围型的肌钙蛋白I分别为0.03（0.01,0.11）和0.01 （0,0.04）μg/L,差异有统计学意义（Z=-2.799,P=0.005）;其余如D-二聚体等实验室检查在两组间差异无统计学意义（P值均〉0.05）.在CTPA各种继发影像表现中,中央型出现肺动脉干增粗、右心增大、肺梗死、马赛克征的例数分别为47、41、23、24例,周围型分别为20、11、11、15例,中央型各征象的发生率高于周围型,差异有统计学意义（χ^2=分别为28.002、34.214、8.221、5.064,P均〈0.05）.结论中央型急性肺栓塞危险程度更高,更易引起一系列的继发改变.确定栓塞类型对临床判断预后及选择治疗方式有一定的价值.

Objective To investigate the clinical correlative factors and CT pulmonary angiography （CTPA） characteristics of secondary changes of chest in different types of acute pulmonary embolism. Methods One hundred and fifty-two cases with acute pulmonary embolism diagnosed by CTPA between January 2015 and October 2016 were retrospectively analyzed.They were divided into central（70 cases）and peripheral （82 cases） groups according to the embolization site. The clinical characteristics （including gender, age, risk stratification, etc.）, laboratory findings （including D-dimer, etc.） and secondary imaging findings（including enlargement of the main pulmonary artery and enlargement of right heart,etc.）of the two groups were recorded. The parameters including patient age, body mass index, length of hospital stay and laboratory findings between the two groups were compared using independent sample t test or Mann-Whitney U test. The other variables including the clinical characteristics such as gender, smoking history, etc. and secondary imaging findings between the two groups were analyzed by χ^2=test and Fisher exact test.Results The high,moderate and low-risk patients were 7,33,30 cases,respectively in the central group,and 2,16, 64 cases, respectively in the peripheral group. The percentages of moderate and high-risk patients in the central group were higher than peripheral group,the difference of risk stratification between the two groups was statistically significant（P〈0.001）.In the choice of clinical treatment,there were 5 cases of thrombolytic therapy in the central group and 0 cases in the peripheral group, and the difference was statistically significant （P= 0.019）. The other differences of clinical characteristics such as gender and age were not statistically significant（P〉0.05）.The cardiac troponin I was 0.03（0.01,0.11）μg/L in the central group and 0.01 （0,0.04） μg/L in the peripheral group, and the difference was statistically significant （Z=-2.799, P=0.005）.The other laboratory findings such as D-dimer were not statistically significant between the two groups （P〉0.05）. Among the various secondary changes of the chest on CTPA, the cases of enlargement of the main pulmonary artery,enlargement of right heart,pulmonary infarction,mosaic perfusion were 47,41, 23, 24 cases, respectively in the central group, and 20, 11, 11, 15 cases, respectively in the peripheral group.The percentages of these signs were higher in the central group than peripheral group,the differences were statistically significant （χ^2= 28.002,34.214,8.221,5.064, P〈0.05）. Conclusions Central acute pulmonary embolism is more dangerous and more likely to cause a series of secondary changes.Determining the type of embolism has certain value for clinical doctors to judge the prognosis and choose the treatment.