本文關(guān)鍵詞： CAT評分 胸部CT血管測量 肺動(dòng)脈高壓 閾值　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的了解CAT評分、主肺動(dòng)脈直徑(MPAD)、主肺動(dòng)脈/升主動(dòng)脈直徑比(rPA)、主肺動(dòng)脈/降主動(dòng)脈直徑比(rPD)與COPD相關(guān)肺動(dòng)脈高壓的相關(guān)性,分析其對COPD相關(guān)肺動(dòng)脈高壓的預(yù)測價(jià)值。方法收集2015年12月至2016年6月安徽醫(yī)科大學(xué)第一附屬醫(yī)院呼吸內(nèi)科經(jīng)過積極治療,患者急性加重期癥狀穩(wěn)定、缺氧改善時(shí)的COPD患者共174例。所有患者在入院時(shí)統(tǒng)計(jì)年齡、性別、吸煙情況、身高、體重等信息,在出院前一天于我院行心臟彩超和胸部CT檢查,對其講解CAT量表進(jìn)行CAT評分。應(yīng)用Carestream軟件對胸部CT圖像進(jìn)行血管直徑測量,依據(jù)測量結(jié)果分別計(jì)算出MPAD、rPA、rPD。根據(jù)心臟彩超結(jié)果將所有患者分為肺動(dòng)脈壓力正常組、輕度增高組、中—重度增高組三個(gè)組別,比較三組間年齡、性別、吸煙比例、體重指數(shù)(BMI)等一般資料。比較三組間CAT評分、MPAD、rPA、rPD的差異性,分析其與肺動(dòng)脈壓力的相關(guān)性。繪制ROC曲線,了解CAT評分、MPAD、rPA、rPD預(yù)測COPD相關(guān)肺動(dòng)脈高壓的閾值,分析其預(yù)測COPD相關(guān)肺動(dòng)脈高壓的價(jià)值,結(jié)果1.正常組、輕度增高組、中—重度增高組三個(gè)組別在年齡、性別、BMI方面的差異均無統(tǒng)計(jì)學(xué)意義(P0.05),在吸煙比例方面差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.輕度增高組的CAT評分、MPAD、rPD均高于正常組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),rPA差異無統(tǒng)計(jì)學(xué)意義(P0.05);中—重度增高組的CAT評分、MPAD、rPA、rPD均高于正常組及輕度增高組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3.CAT評分、MPAD、rPA、rPD與肺動(dòng)脈壓力均成正相關(guān),差異有統(tǒng)計(jì)學(xué)意義(P0.01)。4.CAT評分、MPAD、rPA、rPD預(yù)測COPD相關(guān)輕度肺動(dòng)脈高壓的閾值分別是21分、33.5 mm、0.95、1.12,預(yù)測COPD相關(guān)中—重度肺動(dòng)脈高壓的閾值分別是28分、35.5 mm、1.02、1.20。5.CAT評分聯(lián)合MPAD、rPA、rPD預(yù)測COPD相關(guān)輕度肺動(dòng)脈高壓可兼顧靈敏度與特異度。CAT評分聯(lián)合MPAD、rPA、rPD預(yù)測COPD相關(guān)中—重度肺動(dòng)脈高壓的靈敏度與特異度均較單項(xiàng)指標(biāo)高結(jié)論CAT評分、MPAD、rPA、rPD可作為COPD相關(guān)肺動(dòng)脈高壓的預(yù)測指標(biāo)。CAT評分聯(lián)合胸部CT血管測量預(yù)測COPD相關(guān)肺動(dòng)脈高壓優(yōu)于單一指標(biāo)。當(dāng)CAT評分21分、MPAD33.5 mm、rPA0.95、rPD1.12提示COPD患者并發(fā)輕度肺動(dòng)脈高壓。當(dāng)CAT評分28分、MPAD35.5 mm、rPA1.02、rPD1.20提示COPD患者并發(fā)中—重度肺動(dòng)脈高壓。
[Abstract]:Objective to investigate the correlation between CAT score, aorta diameter, aorta / ascending aorta diameter ratio, aorta / descending aorta diameter ratio and COPD associated pulmonary hypertension. Methods from December 2015 to June 2016, the respiratory department of the first affiliated Hospital of Anhui Medical University was actively treated, and the symptoms of acute exacerbation were stable. There were 174 patients with COPD who had improved anoxia. All the patients had their age, sex, smoking status, height, weight and other information at the time of admission. The day before discharge, they were examined by echocardiography and chest CT in our hospital. Using Carestream software to measure the diameter of blood vessels in chest CT images and calculate the MPAD rPArPD. according to the results of echocardiography, all the patients were divided into two groups: normal pulmonary artery pressure group and slightly elevated pulmonary artery pressure group, according to the results of color Doppler echocardiography, all the patients were divided into two groups: normal pulmonary artery pressure group and slightly elevated pulmonary artery pressure group. The age, sex, smoking ratio, body mass index (BMI) of the three groups were compared. The differences of CAT score and pulmonary artery pressure were compared among the three groups, and the correlation between them and pulmonary artery pressure was analyzed. ROC curves were plotted. To understand the threshold value of CAT score in predicting COPD associated pulmonary hypertension and analyze its value in predicting COPD associated pulmonary hypertension. 1. Age was observed in normal group, mild elevated group and moderate to severe elevated group. There was no significant difference in sex and BMI (P 0.05), but there was significant difference in smoking ratio (P 0.05). The CAT score of mild increase group was higher than that of normal group. There was no significant difference in CAT between moderate and severe elevated group (P 0.05). The CAT score of moderate to severe elevation group was significantly higher than that of normal group and mild elevated group, and the difference was statistically significant (P 0.05). 3. Cat score showed a positive correlation with pulmonary artery pressure. The threshold value of MPADrPARPD for predicting mild pulmonary hypertension associated with COPD was 21 / 33.5 mm / 0. 95 鹵1.12, respectively. The thresholds for predicting moderate to severe pulmonary hypertension associated with COPD were 28 / 35.5 mm / 1. 02 鹵1. 20. 5 cat scores combined with MPADrPArPD for predicting mild COPD correlation. The sensitivity and specificity of COPD associated moderate to severe pulmonary hypertension were higher than that of the single index. Conclusion CAT score and CAT score can be used as a predictor of COPD associated pulmonary hypertension. Cat score combined with chest CT angiography was superior to single index in predicting pulmonary hypertension associated with COPD. When CAT score was 21, MPAD33.5 mmPA0.95rPD1.12 indicated that COPD patients had mild pulmonary hypertension, and when CAT score 28, MPAD35.5 mmPA1.02rPD1.20 suggested that COPD patients complicated with pulmonary hypertension. -severe pulmonary hypertension.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1;R563.9

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