【摘要】：背景： 肺栓塞（acute pulmonary cmbolismPE）是一種發(fā)病率和死亡率均較高的疾病，有研究表明，近年來我國(guó)肺栓塞數(shù)量正在逐年增加，因此在對(duì)PE做出正確診斷的同時(shí)，，需對(duì)其病情的嚴(yán)重程度進(jìn)行相關(guān)的評(píng)估，為臨床的治療決策、療效評(píng)價(jià)及預(yù)后判斷等提供客觀、科學(xué)依據(jù)。 目的： 利用CT肺動(dòng)脈造影（CT pulmonary angiography CTPA）的“CT肺動(dòng)脈阻塞指數(shù)”定量分析PE患者肺動(dòng)脈阻塞的程度；研究“CT肺動(dòng)脈阻塞指數(shù)”和動(dòng)脈血?dú)夥治觥⑿募?biāo)志物及凝血指標(biāo)之間的關(guān)系，并評(píng)價(jià)PE的嚴(yán)重度。 方法： 回顧性分析我院2009年11月至2011年9月通過我院雙源CT肺動(dòng)脈造影成像確診肺栓塞的24例入院患者。采用Spearman等級(jí)相關(guān)系數(shù)評(píng)價(jià)CT阻塞指數(shù)與各項(xiàng)生化指標(biāo)之間的相關(guān)性；用Mann-Whitney U檢驗(yàn)來評(píng)價(jià)高于或低于不同CT肺動(dòng)脈阻塞指數(shù)（35%，45%，55%，65%）時(shí)的各項(xiàng)生化指標(biāo)之間是否有統(tǒng)計(jì)學(xué)差異。 結(jié)果： 1、肺動(dòng)脈阻塞程度和動(dòng)脈血?dú)夥治鲋蠵aO2、P (A-a)O2存在相關(guān)性，且PaO2、P (A-a)O2可以對(duì)肺動(dòng)脈阻塞嚴(yán)重性進(jìn)行評(píng)估。PE患者的PO2、P (A-a)O2在CTI%為55%、65%閾值水平上下差異有顯著意義， 2、肺動(dòng)脈阻塞程度和凝血指標(biāo)、D-Dimer之間存在相關(guān)性，相關(guān)性依次為APTT、INR、D-dimer、PT，并可以通過這四個(gè)化驗(yàn)指標(biāo)對(duì)肺動(dòng)脈阻塞嚴(yán)重行進(jìn)行評(píng)估。APTT在PE患者CTI%為55%、65%閾值上下時(shí)比PT、INR、D-Dimer更敏感；而當(dāng)PE患者CTI%為35%為時(shí)PT較其他三項(xiàng)更加敏感。 3、肺動(dòng)脈阻塞程度和心肌標(biāo)志物中的ALT、AST、LDH之間存在相關(guān)性，且以AST相關(guān)性最大，ALT次之，LDH最小，并可以通過此三項(xiàng)化驗(yàn)指標(biāo)對(duì)肺動(dòng)脈阻塞嚴(yán)重行進(jìn)行評(píng)估。 ALT、AST在PE患者CTI%為35%閾值上下時(shí)較LDH敏感，在PE患者CTI%為45%、55%、65%閾值上下時(shí)ALT、AST、LDH同樣敏感。 結(jié)論： 動(dòng)脈血?dú)夥治�、凝血功能指�?biāo)、D-dimer、心肌標(biāo)志物與CT肺動(dòng)脈阻塞指數(shù)之間有相關(guān)性，并可以定量化評(píng)估急性肺動(dòng)脈栓塞的嚴(yán)重程度。
[Abstract]:Background: pulmonary embolism (acute pulmonary cmbolismPE) is a disease with high morbidity and mortality. Studies have shown that the number of PE in China is increasing year by year in recent years. Therefore, the correct diagnosis of PE is made at the same time. It is necessary to evaluate the severity of the disease in order to provide objective and scientific basis for clinical treatment decision, curative effect evaluation and prognosis judgment. Objective: to quantitatively analyze the degree of pulmonary artery obstruction in patients with PE by using the "CT pulmonary artery occlusion index" of (CT pulmonary angiography CTPA) on CT pulmonary angiography. To study the relationship between "CT pulmonary artery occlusion index" and arterial blood gas analysis, myocardial markers and coagulation indexes, and to evaluate the severity of PE. Methods: from November 2009 to September 2011, 24 patients with pulmonary embolism diagnosed by dual-source CT pulmonary angiography were retrospectively analyzed. Spearman grade correlation coefficient was used to evaluate the correlation between CT blocking index and biochemical indexes. Mann-Whitney U test was used to evaluate whether there were statistical differences between the biochemical indexes of different CT pulmonary artery occlusion indexes (35%, 45%, 55%, 65%). Results: 1. There was a correlation between the degree of pulmonary artery obstruction and PaO2,P (a) O 2 in arterial blood gas analysis, and the severity of pulmonary artery obstruction could be evaluated by PaO2,P (a) O 2. PO2, in PE patients P (A _ (a) O _ 2) was 55% in CTI% and 65% in threshold level. 2, the degree of pulmonary artery obstruction was correlated with coagulation index and D-Dimer, and the correlation in turn was APTT,INR,D-dimer,PT,. These four indexes can be used to evaluate the severe pulmonary artery obstruction. APTT is 55% of CTI% in patients with PE, and more sensitive than PT,INR,D-Dimer when the threshold of 65% is above or below the threshold. When CTI% was 35% in PE patients, PT was more sensitive than the other three items. (3) there was a correlation between the degree of pulmonary artery obstruction and ALT,AST,LDH in myocardial markers, and the correlation of AST was the highest, ALT was the second, and LDH was the least, and the severity of pulmonary artery obstruction could be evaluated by these three indexes. ALT,AST was more sensitive than LDH when CTI% was 35% or lower in PE, 45%, 55% and 65% in PE, respectively. ALT,AST,LDH was also sensitive when CTI% was above or below the threshold of 65%. Conclusion: arterial blood gas analysis, coagulation function, D-dimer and myocardial markers are correlated with CT pulmonary artery occlusion index, and the severity of acute pulmonary embolism can be quantitatively evaluated.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.5

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