肺小血管截面积定量测量在肺栓塞患者右心功能检测中的应用

Quantitative measurement of cross-sectional area of small pulmonary vessels in pulmonary embolism

目的探讨基于胸部CT肺动脉造影(CTPA)定量测量的肺小血管与肺截面积比值(%CSA)与肺栓塞患者右心功能相关指标的相关性。方法回顾性分析2018—2019年宁夏医科大学总医院行CTPA检查的120例肺栓塞患者和72名健康志愿者的资料,120例患者中男54例,女66例,年龄25~88岁,平均(59±13)岁;志愿者中男30名,女42名,年龄30~78岁,平均(61±12)岁。测量研究对象的肺动脉主干内径(mPA)、肺主动脉与升主动脉内径比值(rPA)、右心室/左心室最大横径比值(RVd/LVd)及肺动脉阻塞指数(PAOI)。采用Image J处理软件于CTPA图像上测量所有研究对象的%CSA(肺小血管截面积<5 mm2和5~10 mm2分别表示为%CSA<5和%CSA5-10)。根据危险分层指标将患者分为中高危组(RVd/LVd>1)和低危组(RVd/LVd<1)2个亚组。中高危组、低危组及对照组各指标间的比较采用方差分析,亚组间各指标的比较采用独立样本t检验,采用spearman相关法分析PE组%CSA与右心室功能参数间的相关性。结果中高危组、低危组与对照组间的%CSA<5分别为(0.69±0.19)%、(0.95±0.27)%和(0.99±0.30)%,差异有统计学意义(P<0.01),3组的%CSA5-10分别为(0.63±0.15)%、(0.84±0.18)%和(0.85±0.25)%,差异有统计学意义(P<0.01),中高危组%CSA<5、%CSA5-10均小于低危组及对照组。相关性分析发现,中高危和低危组%CSA<5、%CSA5-10与RVd/LVd、mPA、rPA均呈负相关(r值分别为-0.543和-0.484,-0.367和-0.495,-0.236和-0.352)。结论基于CTPA定量测量的%CSA<5及%CSA5-10与肺栓塞患者RVd/LVd呈负相关,在一定程度上间接反映了病情的严重程度。

Objective The relationship between the percentage of total cross-sectional area(%CSA)of small pulmonary vessels for the lung area in CTPA and the right ventricular function parameters in patients with pulmonary embolism.Methods 120 patients with PE and 72 healthy subjects underwent CTPA and all date were analyzed Retrospectively.The main pulmonary artery diameter(mPA),the ratio of the main pulmonary artery to the ascending aorta diameter(rPA),right ventricle/left ventricular diameter ratio(RVd/LVd),and the pulmonary artery obstruction index(PAOI)in the PE group were measured for all subjects.The%CSA<5 mm2 and 5-10 mm2 for the lung area(%CSA<5 and%CSA5-10)of small pulmonary vessels were measured with Image J image-processing program.According to the risk stratification of the 2018 Guidelines for the Diagnosis and Treatment of Pulmonary Thromboembolism,PE patients were divided into medium-high risk group(RVd/LVd>1)and low-risk group(RVd/LVd<1).The indexes of PE in medium-high risk group,low risk group and control group were compared by ANOVA,and the indexes among PE subgroups were compared by independent sample t-test.Spearman correlation method was used to analyze the correlation between%CSA and right ventricular function parameters of PE patients.Results%CSA<5 of medium-high risk group,low-risk group and control group were(0.69±0.19)%,(0.95±0.27)%and(0.99±0.30)%(P<0.01),respectively.%CSA5-10 of three groups were(0.63±0.15)%,(0.84±0.18)%,and(0.85±0.25)%(P<0.01),respectively;%CSA<5 and%CSA5-10 of medium-high risk group were lower than low-risk group and control group.%CSA<5 and%CSA5-10 in PE patients correlated negatively with RVd/LVd,rPA and mPA(r=-0.545/-0.549,-0.235/-0.352,-0.239/-0.298,respectively).Conclusion The measurement of%CSA<5 and%CSA 5-10 in CTPA were negatively correlated with RVd/LVd in patients with pulmonary embolism,which indirectly reflected the severity of the pulmonary embolism patients.