回顾性心电门控CT肺动脉成像评估慢性肺栓塞患者右心功能及肺动脉膨胀性的价值

Application value of retrospective ECG-gated CT pulmonary angiography in the evaluation of the right ventricular function and pulmonary artery distensibility in patients with chronic pulmonary embolism

目的:探讨ECG-gated CT肺动脉成像(CTPA)评估慢性肺栓塞患者的右心室功能、肺动脉膨胀性的应用价值。方法:2017年2月至8月,于我院行CTPA检查患者中筛选出慢性肺栓塞(实验组)40例,正常组(对照组)33例;并根据右心室射血分数(EF)将实验组细化分为:A组26例(EF>50%)、B组14例(EF<50%)。测量各级肺动脉[主肺动脉(MPA)、左肺动脉(LPA)、右肺动脉(RPA)及左/右段级肺动脉(LsPA/RsPA)]的最大截面积(CSA_(max))、最小截面积(CSAmin)并计算肺动脉膨胀性(DPA)。比较实验组与对照组、实验组中A组与B组最大截面积、最小截面积及肺动脉膨胀性的差异,并行肺动脉膨胀性与右心室功能的相关分析。结果:实验组近端肺动脉的最大、最小截面积均高于对照组[MPACSA_(max)(804.00±233.47)vs.(648.82±196.13)mm^2,P<0.01;MPACSA_(min)(719.30±231.94)vs.(563.64±159.39)mm^2,P<0.01;LPACSA_(max)(476.43±120.11)vs.(411.21±90.65)mm^2,P=0.01;LPACSA_(min)(421.10±116.34)vs.(366.58±91.14)mm^2,P=0.03;RPACSA_(max)(548.10±141.89)vs.(485.21±135.71)mm^2,P=0.06;RPACSA_(min)(466.18±147.81)vs.(407.12±122.72)mm^2,P=0.07]。实验组的近端肺动脉膨胀性与对照组相近(P>0.05),而段级肺动脉膨胀性则低于对照组(P<0.05)。实验组中B组(EF<50%)左、右肺动脉膨胀性低于A组(EF>50%)(P<0.05),而两组段级肺动脉的膨胀性则无显著差异(P>0.05)。各级肺动脉膨胀性与RVEF无明显相关。结论:回顾性ECG-gated CTPA检查评估慢性肺栓塞的右心功能及肺动脉膨胀性,发现段级肺动脉膨胀性减低可能早于近端肺动脉;当近端肺动脉膨胀性也下降时,可能伴随着右心衰竭。依据右心功能、肺动脉膨胀性变化评估慢性肺栓塞患者病情进展,从而采取不同治疗策略提高患者生存率具有潜在价值。

Objective： The purpose of this study was to evaluate the value of ECG-gated CT pulmonary artery imaging(CTPA） in the right ventricular function and pulmonary artery distensibility in patients with chronic pulmonary embolism. Methods： From February 2017 to August,40 patients with chronic pulmonary embolism(experimental group） and 33 normal subjects(control group） were screened by CTPA examination in our hospital. According to the right ventricular ejection fraction(ejection fraction,EF）,the experimental group was divided into two groups： group A(26 cases,EF 〉50%） and group B(14 cases,EF 〈50%）. The maximum cross-sectional area(CSAmax）,the minimum cross-sectional area(CSAmin） of pulmonary arteries and pulmonary artery dilatability(DPA） were measured at all levels,Including： the main pulmonary artery(MPA）,left pulmonary artery(LPA）,right pulmonary artery(RPA） and the left/right segmental pulmonary artery (LsPA/RsPA）. The differences of maximum cross-sectional area,minimum cross-sectional area and pulmonary artery dilatability between the experimental group and the control group,and between group A and group B were compared. The correlation between pulmonary artery dilatability and right ventricular function was also analyzed. Results： The maximum and minimum sectional area of the proximal pulmonary artery in the experimental group were higher than those in the control group [MPACSAmax(804. 00 ± 233. 47） vs.(648. 82 ± 196. 13）mm^2,P〈0. 01; MPACSAmin(719. 30 ± 231. 94） vs.(563. 64 ± 159. 39） mm^2,P〈0. 01; LPACSAmax(476. 43± 120. 11） vs.(411. 21 ± 90. 65） mm^2,P = 0. 01; LPACSAmin(421. 10 ± 116. 34） vs.(366. 58 ± 91. 14） mm^2,P = 0. 03; RPACSAmax(548. 10 ± 141. 89） vs.(485. 21 ± 135. 71） mm^2,P = 0. 06; RPACSAmin(466. 18 ±147. 81） vs.(407. 12 ± 122. 72） mm^2,P = 0. 07]. The pulmonary artery dilatability of the experimental group was similar to that of the control group(P〈0. 05）,while the segmental pulmonary artery dilation was lower than that of the control group(P〈0. 05）. The dilatability of the left and right pulmonary arteries in group B(EF 〈50%） were lower than that in group A(EF 〉50%,P〈0. 05）,but there was no significant difference in the dilatability of the pulmonary arteries between the two segments pulmonary(P〉0. 05）. Conclusion：Retrospective ECG-gated CTPA examination can assess right ventricular function and pulmonary artery dilation in patients with chronic pulmonary embolism. The reduction of dilatability on segmental pulmonary artery may be earlier than the proximal pulmonary artery. When the dilatability of the proximal pulmonary artery decreased,maybe accompanied by the decreased of right ventricular heart failure. Evaluate the progression of chronic pulmonary embolism based on the changes of right heart function and pulmonary artery distensibility,which is potential value to improve the survival rate after take different treatment strategies.