本文選題：肺動脈高壓　切入點：分級　出處：《川北醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:利用CT肺動脈成像(Computed tomography pulmonary angiography,CTPA)探討肺動脈相關參數(shù)與肺動脈高壓(pulmonary hypertension,PH)之間的相關性,并篩選出與PH相關性較高的參數(shù),探討其對PH分級的價值。方法:本研究經(jīng)川北醫(yī)學院倫理委員會的批準;按照多普勒超聲心動圖根據(jù)測算肺動脈收縮壓(pulmonary artery systolic pressure,PASP)對PH進行診斷及分級的標準,選取2013年1月至2016年9月間至川北醫(yī)學院附屬醫(yī)院就診的PH患者100例(PH患者組)及同時期肺動脈壓力正常的受檢者30例(正常對照組),同時將PH患者分為輕度組(45例)、中度組(42例)和重度組(13例),排除碘過敏及病危不能耐受檢查者。在CTPA圖像上測量其肺動脈干(the main pulmonary artery inner diameter,MPAD)、同層面升主動脈(the aortic inner diameter,AD)、右肺動脈干(the right pulmonary artery inner diameter,RPAD)、右下肺動脈干(right lower pulmonary artery inner diameter,RLPAD)、右肺下葉后基底段動脈及左肺動脈干(the left pulmonary artery inner diameter,LPAD)、左肺下葉后基底段動脈的內(nèi)徑,計算肺動脈干與升主動脈內(nèi)徑的比值(the main pulmonary artery inner diameter/aortic inner diameter,PA/A)。計量資料采用成組t檢驗,采用單因素方差分析法比較輕、中、重度PH患者各肺動脈相關參數(shù)的差異,采用LSD法分析肺動脈相關參數(shù)兩兩之間的差異,采用Spearman等級相關分析各肺動脈相關參數(shù)與PH之間的相關性,采用受試者工作特征曲線(the receiver operating characteristic,ROC)確立與PH相關性較高的肺動脈相關參數(shù)于輕、中、重度PH患者組的各自最佳閾值。結(jié)果:(1)肺動脈相關參數(shù)在正常對照組與PH患者組的差異具有統(tǒng)計學意義(p0.05);(2)輕、中、重度PH患者組的各肺動脈相關參數(shù)之間的差異具有統(tǒng)計學意義(p0.05);(3)兩兩比較中,輕、中、重度PH患者組的MPAD、PA/A、RLPAD及右肺下葉后基底段動脈內(nèi)徑的兩兩比較均具有統(tǒng)計學意義(p0.05),且與PH相關性較高,相關系數(shù)分別為0.454,0.669,0.433,0.496(p0.05)。(4)輕、中及重度PH患者組的各自最佳閾值均不同(p0.05):MPAD分別為26.04mm、29.78mm、32.54mm,ROC曲線下的面積(area under the ROC curve,AUC)分別為0.920、0.727、0.756;PA/A分別為0.76、0.94、1.05,AUC值分別為0.677、0.851、0.745;RLPAD分別為14.71mm、17.33mm、17.53mm,AUC值分別為0.719、0.684、0.687;右肺下葉后基底段動脈分別為2.40mm、3.37mm、4.38mm,AUC值分別為0.660、0.668、0.777。結(jié)論:CTPA可以診斷PH,并可用于PH的分級;右肺下葉后基底段動脈內(nèi)徑的變化可作為PH診斷及分級新的參考指標,并協(xié)助其他指標對PH分級的診斷。
[Abstract]:Objective: to investigate the correlation between pulmonary artery related parameters and pulmonary hypertension (PH) by computed tomography pulmonary angiography (CTPA), and to screen the parameters with high correlation with PH. Methods: this study was approved by the Ethics Committee of North Sichuan Medical College, and the criteria for the diagnosis and grading of PH were determined by Doppler echocardiography according to pulmonary artery systolic pressure. From January 2013 to September 2016, 100 patients with PH were selected from affiliated Hospital of North Sichuan Medical College, and 30 patients with normal pulmonary artery pressure at the same time (normal control group). At the same time, PH patients were divided into mild group. 45 cases of pulmonary artery, 42 cases of moderate group) and 13 cases of severe group were excluded from the examination of iodine allergy and critical condition. The main pulmonary artery inner diameterus MPAD were measured on CTPA images, the aortic inner diameterus adterna, the right pulmonary artery of the right pulmonary artery were measured on CTPA images. Inner diameterus, right lower pulmonary artery inner diameterus, posterior basilar artery of right inferior lobe and trunk of left pulmonary artery, inner diameter of left inferior lobe posterior basilar artery, left pulmonary artery, left inferior lobe posterior basilar artery, left inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery, right inferior pulmonary artery and left pulmonary artery. The ratio of the diameter of the pulmonary artery to the ascending aorta was calculated and the main pulmonary artery inner diameter/aortic inner diametera A / A were calculated. The measured data were measured by group t test, and the difference of the pulmonary artery related parameters among the patients with moderate, moderate and severe PH was compared by single factor variance analysis. LSD method was used to analyze the difference of pulmonary artery correlation parameters, and Spearman grade correlation was used to analyze the correlation between pulmonary artery related parameters and PH. Using the receiver operating characteristic curve to determine the pulmonary artery parameters with high correlation with PH. Results the difference of pulmonary artery related parameters between the normal control group and the PH group was statistically significant (p 0.05). The difference of pulmonary artery related parameters among patients with severe PH was statistically significant (p 0.05). In the patients with severe PH, the MPADPA / Agna RLpad and the right inferior lobar posterior basilar artery diameter were significantly higher than those in the right inferior lobar artery, and the correlation with PH was relatively high, the correlation coefficient was 0.454 鹵0.669U 0.433U 0.496p0.05n.4The correlation coefficient was 0. 454 ~ 0. 669 ~ 0. 433nr 0. 496p0. 05 / 0. 4). The optimum threshold values of moderate and severe PH patients were different. The area area under the ROC AUC under the ROC curve were 26.04mm / 29.78mm and 32.54mmROC, respectively. The area under ROC ROC AUC / A was 0.9200.27270.756 / A = 0.760.7941.05AUC = 0.6770.851AUC = 14.71mm 17.33mm 17.53mmA, respectively, and the right sublobar posterior basilar artery was 2.40mm / 3.37mm / 4.38mmA respectively. The values were 0.660 ~ 0.668 ~ 0.777.Conclusion: 1. CTPA can be used in the diagnosis of PH and in the grading of PH. The change of right inferior lobe posterior basilar artery diameter can be used as a new reference index for the diagnosis and grading of PH and assist other indexes in the diagnosis of PH grade.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1;R816.2

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