CT肺动脉造影对康复患者急性肺栓塞及右心功能的评价

doi:10.3969/j.issn.1006-9771.2023.12.007

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (12): 1429-1438.doi: 10.3969/j.issn.1006-9771.2023.12.007

CT肺动脉造影对康复患者急性肺栓塞及右心功能的评价

张红霞¹^,², 丛欣莹¹^,², 张甜¹^,², 武晔¹^,², 李清¹^,², 李雪静¹^,², 陈奕帆¹^,², 王秀婷¹^,², 于卫永¹^,², 陈振波¹^,²()

1.中国康复研究中心北京博爱医院影像科，北京市 100068
2.首都医科大学康复医学院，北京市 100068

收稿日期:2023-08-28 修回日期:2023-11-27 出版日期:2023-12-25 发布日期:2023-12-28
通讯作者: 陈振波，E-mail： 13718632754@163.com
作者简介:张红霞(1985-)，女，汉族，河南濮阳市人，硕士，主治医师，主要研究方向：心胸系统影像及神经系统影像。
基金资助:
中国康复研究中心科研基金项目(2020-Q13)

Application of CT pulmonary angiography in acute pulmonary embolism and right heart function

ZHANG Hongxia¹^,², CONG Xinying¹^,², ZHANG Tian¹^,², WU Ye¹^,², LI Qing¹^,², LI Xuejing¹^,², CHEN Yifan¹^,², WANG Xiuting¹^,², YU Weiyong¹^,², CHEN Zhenbo¹^,²()

1. Department of Imaging, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China

Received:2023-08-28 Revised:2023-11-27 Published:2023-12-25 Online:2023-12-28
Contact: CHEN Zhenbo, E-mail: 13718632754@163.com
Supported by:
China Rehabilitation Research Center Fund for Research(2020-Q13)

摘要/Abstract

摘要：

目的探究CT肺动脉造影(CTPA)对康复患者急性肺栓塞(APE)严重程度的判断及其对右心功能评价的应用价值。

方法 2013年1月至2020年1月，北京博爱医院康复住院并行CTPA检查的患者133例，其中阳性94例，阴性39例。阳性患者根据肺动脉栓塞指数(PAOI)评分进一步分为轻度、中度、重度组。比较4组间临床参数和右心功能指标差异。采用Spearman相关性分析研究PAOI与临床参数和右心功能指标的相关性，采用Logsitic回归分析预测康复患者APE发病的危险因素。

结果各组间下肢静脉血栓、D-二聚体、氧分压、PAOI、室间隔左突比较均有非常显著性差异(H ≥ 12.350, P < 0.01)。PAOI与D-二聚体(r = 0.443, P < 0.001)和室间隔左突(r = 0.520, P < 0.001)呈中度正相关，与下肢静脉血栓(r = 0.399, P < 0.001)、左肺动脉直径(r = 0.213, P = 0.014)和下腔静脉反流(r = 0.229, P = 0.008)弱相关。下肢静脉血栓(OR = 7.708, P < 0.001)、室间隔左突(OR = 3.641, P = 0.008)为康复患者APE发病的独立危险因素。这两个指标具有较高的APE联合诊断效能，其操作者工作特征曲线下面积为0.795 (95%CI 0.715~0.874)。

结论 CTPA可用于评价康复患者APE严重程度和右心功能。

关键词: CT肺动脉造影, 急性肺栓塞, 右心功能

Abstract:

Objective To explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients.

Methods From January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE.

Results There was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P< 0.001) and left process of interventricular septum (OR = 3.641, P= 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874).

Conclusion CTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.

Key words: CT pulmonary angiography, acute pulmonary embolism, right heart function

中图分类号:

R563.5

张红霞, 丛欣莹, 张甜, 武晔, 李清, 李雪静, 陈奕帆, 王秀婷, 于卫永, 陈振波. CT肺动脉造影对康复患者急性肺栓塞及右心功能的评价[J]. 《中国康复理论与实践》, 2023, 29(12): 1429-1438.

ZHANG Hongxia, CONG Xinying, ZHANG Tian, WU Ye, LI Qing, LI Xuejing, CHEN Yifan, WANG Xiuting, YU Weiyong, CHEN Zhenbo. Application of CT pulmonary angiography in acute pulmonary embolism and right heart function[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(12): 1429-1438.

图/表 6

图1

表1

各组间临床参数和右心功能指标比较"

项目	阴性组 (n = 39)	阳性组(n = 94)			H/F值	P值
项目	阴性组 (n = 39)	轻度组 (n = 55)	中度组 (n = 17)	重度组 (n = 22)	H/F值	P值
性别/n					0.541	0.910
男	13	22	7	8
女	26	33	10	14
年龄/岁	62.00(51.00, 72.00)	65.00(52.00, 72.00)	62.00(54.50, 75.00)	66.00(57.75, 73.00)	1.013	0.798
损伤部位/n					2.116	0.549
无神经系统损伤	10	7	2	3
脑部损伤	24	39	13	16
脊髓损伤	5	9	2	3
下肢静脉血栓/n					26.255	< 0.001
无	20	7	1	2
有	19	48	16	20
发病前抗凝/抗血小板治疗/n					1.265	0.738
无	20	30	8	14
有	19	25	9	8
肢体活动不利/n					0.611	0.894
无	9	10	2	4
一侧肢体活动不利	19	33	10	13
两侧肢体活动不利	11	12	5	5
ADL评分	20.00(5.00, 60.00)	20.00(5.00, 35.00)	15(5.00, 40.00)	22.50(5.00, 46.25)	1.328	0.723
D-二聚体/(mg•L^-1)	2.17(1.01, 5.69)^a	3.93(2.11, 8.14)^a,b	8.91(4.50, 20.58)^b	11.04(3.80, 18.88)^b	24.775	< 0.001
氧分压/mmHg	74.40(65.50, 87.50)^a,b	77.80(70.80, 85.00)^a	81.00(66.00, 90.25)^a,b	64.05(58.03, 77.73)^b	12.350	0.006
二氧化碳分压/mmHg	39.00(36.00, 41.80)	38.40(35.90, 41.00)	37.60(33.60, 40.60)	36.00(33.95, 40.60)	2.962	0.398
PAOI/%	0.00(0.00, 0.00)^a	15.00(5.00, 22.50)^b	42.50(36.25, 45.00)^c	50.00(50.00, 50.00)^c	122.082	< 0.001
RVD/LVD	0.86(0.75, 1.13)	0.91(0.82, 1.06)	1.04(0.84, 1.16)	0.98(0.81, 1.19)	4.948	0.176
RVA/LVA	0.81(0.67, 0.93)	0.76(0.65, 0.93)	0.81(0.74, 0.92)	0.81(0.71, 1.04)	2.113	0.549
主肺动脉直径/mm	27.70(25.37, 30.24)	27.12(24.82, 30.53)	26.47(25.34, 29.64)	29.09(26.42, 30.93)	1.831	0.608
右肺动脉直径/mm	21.99±3.53	21.91±3.74	21.34±2.29	24.01±3.95	2.374	0.073
左肺动脉直径/mm	20.43±3.26	20.93±3.45	21.30±2.97	22.33±2.76	1.678	0.175
室间隔左突/n					47.058	< 0.001
正常	32	40	7	1
平直	7	15	9	16
左突	0	0	1	5
下腔静脉反流/n					7.491	0.058
无	19	26	5	4
有	20	29	12	18
奇静脉反流/n					4.652	0.199
无	13	15	1	6
有	26	40	16	16

表1

表2

表3

图2

表4

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变量	单变量Logistic回归				多变量Logistic回归
变量	B	P值	OR	95%CI	B	P值	OR	95%CI
性别	-0.261	0.514	0.770	(0.352, 1.687)
年龄	0.018	0.181	1.019	(0.992, 1.046)
损伤部位	0.493	0.160	1.637	(0.822, 3.260)
下肢静脉血栓	2.180	< 0.001	8.842	(3.567, 21.919)	2.042	< 0.001	7.708	(3.008, 19.754)
发病前抗凝/抗血小板治疗	-0.162	0.671	0.850	(0.402, 1.796)
肢体活动不利	0.029	0.920	1.029	(0.584, 1.816)
ADL评分	-0.012	0.051	0.988	(0.975, 1.000)
D二聚体	0.055	0.058	1.056	(0.998, 1.118)
氧分压	-0.001	0.909	0.999	(0.977, 1.021)
二氧化碳分压	-0.026	0.480	0.975	(0.907, 1.047)
RVD/LVD	1.407	0.112	4.085	(0.721, 23.141)
RVA/LVA	0.473	0.548	1.605	(0.343, 7.520)
主肺动脉直径	0.003	0.948	1.003	(0.915, 1.099)
右肺动脉直径	0.024	0.656	1.024	(0.923, 1.136)
左肺动脉直径	0.087	0.153	1.091	(0.968, 1.229)
室间隔左突	1.427	0.001	4.165	(1.739, 9.976)	1.292	0.008	3.641	(1.411, 9.396)
下腔静脉反流	0.471	0.221	1.601	(0.753, 3.405)
奇静脉反流	0.492	0.239	1.636	(0.721, 3.713)

CT肺动脉造影对康复患者急性肺栓塞及右心功能的评价

Application of CT pulmonary angiography in acute pulmonary embolism and right heart function

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项目	PAOI
项目	r值	P值
性别	-0.041	0.642
年龄	0.081	0.356
损伤部位	0.097	0.267
下肢静脉血栓	0.399	< 0.001
发病前抗凝/抗血小板治疗	-0.020	0.821
肢体活动不利	0.022	0.804
ADL评分	-0.017	0.847
D-二聚体	0.443	< 0.001
氧分压	-0.103	0.237
二氧化碳分压	-0.162	0.062
RVD/LVD	0.153	0.078
RVA/LVA	0.108	0.214
主肺动脉直径	0.088	0.315
右肺动脉直径	0.070	0.423
左肺动脉直径	0.213	0.014
室间隔左突	0.520	< 0.001
下腔静脉反流	0.229	0.008
奇静脉反流	0.066	0.453

项目	赋值
性别	0 =女，1 =男
损伤部位	0 =无神经系统损伤，1 =脑部损伤，2 =脊髓损伤
下肢静脉血栓	0 =无，1 =有
发病前抗凝/抗血小板治疗	0 =无，1 =有
肢体活动不利	0 =无，1 =一侧肢体活动不利，2 =两侧肢体活动不利
室间隔左突	0 =正常，1 =平直，2 =左突
下腔静脉反流	0 =无，1 =有
奇静脉反流	0 =无，1 =有