基于形态学定量指标预测急性肺栓塞患者治疗后血栓溶解程度

The value of predicting thrombolysis in patients with acute pulmonary embolism based on quantitative morphological indicators

目的探讨急性肺栓塞患者栓子的形态学定量参数在预测血栓治疗效果中的价值。方法选取21例急性肺栓塞患者且治疗前后均行CT肺动脉造影。根据复查结果,将患者分为血栓完全溶解组(6例患者,39个血栓)和血栓未完全溶解组(15例患者,101个完全溶解血栓和48个未完全溶解血栓)。自动提取血栓并得出每个血栓的位置、体积、断面阻塞程度、长度、最大密度、平均密度和最小密度。比较完全溶解和未完全溶解血栓的差异,并构建受试者操作特征曲线,多因素回归分析栓子治疗效果的独立预测因素。结果完全溶解的血栓体积小、长度短、断面阻塞程度低、最大密度低、平均密度高、最小密度高、多位于右肺及下叶(P<0.05),曲线下面积分别为0.916、0.877、0.734、0.709、0.682、0.702、0.538、0.639(P<0.05)。多因素回归分析显示,长度〔1.133(1.080~1.188)〕、平均密度〔0.945(0.904~0.988)〕和栓子位于下叶〔0.263(0.114~0.607)〕是治疗效果的独立预测因素(P<0.05)。结论血栓体积小、长度短、栓塞程度低、最大密度低、平均密度和最小密度高、位于右肺和下叶治疗后更易溶解。长度、平均密度和位于右肺是治疗效果的独立预测因素。

Objective To explore the value of quantitative morphological parameters of emboli in patients with acute pulmonary embolism in predicting the therapeutic effect of thrombosis.Methods 21 patients with acute pulmonary embolism were collected retrospectively and CT pulmonary angiography was performed before and after treatment.According to the results of the review,the patients were divided into a thrombolytic group(6 patients,39 thrombi)and an incomplete thrombolysis group(15 patients,101 the completely thrombolytic and 48 the incompletely thrombolytic).We automatically extracted thrombus and got the position,volume,section obstruction degree,length,maximum density,average density and minimum density of each thrombus.We compared the difference between complete dissolution and incomplete dissolution of thrombus,and constructed a characteristic curve of the operation of the subject.Multivariate regression analysis was used to analyze the independent predictors of better emboli treatment effect.Results Completely dissolved thrombus was small in size,short in length,low in degree of cross-sectional obstruction,low in maximum density,high in average density,high in minimum density,located in the right lung and lower lobe(P<0.05),and the area under the curve was 0.916,0.877,0.734,0.709,0.682,0.702,0.538,0.639(P<0.05).Multivariate regression analysis showed that the length 1.133(1.080 to 1.188),the average density 0.945(0.904 to 0.988)and the embolus located in the lower lobe 0.263(0.114 to 0.607)were independent predictors of the therapeutic effect(P<0.05).Conclusion The thrombus that is small in size,short in length,low in embolism,low in maximum density,high in average density and minimum in density,which is more soluble in the right lung and lower lobe after treatment.Length,average density and right lung are independent predictors of treatment effect.