【摘要】：目的探討回顧性心電門控CTPACT栓塞指數(shù)及心血管參數(shù)評(píng)價(jià)APE患者嚴(yán)重程度的臨床價(jià)值。 方法經(jīng)回顧性心電門控CTPA檢查的患者65例，根據(jù)其疾病的嚴(yán)重風(fēng)險(xiǎn)程度分為高風(fēng)險(xiǎn)APE組20例（組1），非高風(fēng)險(xiǎn)組25例（組2）以及對(duì)照組20例。對(duì)比分析組1、2間Qanadli栓塞指數(shù)以及三組間右室舒張末期容積RVEDV、收縮末期容積RVESV、右左室舒張末期容積比RVEDV/LVEDV、收縮末期容積比RVESV/LVESV、右室每搏輸出量RVSV、右室射血分?jǐn)?shù)RVEF、右室最大短徑RVd4CH、右左室最大短徑比RVd4CH/LVd4CH、主肺動(dòng)脈直徑、主肺動(dòng)脈主動(dòng)脈直徑比、上腔靜脈及奇靜脈短徑、室間隔形態(tài)及下腔靜脈對(duì)比劑返流情況的差異，使用spearman等級(jí)相關(guān)分析CT栓塞指數(shù)與右心形態(tài)功能參數(shù)間的關(guān)系，利用ROC曲線確定回顧性心電門控CTPA所得各參數(shù)診斷APE嚴(yán)重程度的準(zhǔn)確性、敏感度及特異度。 結(jié)果高風(fēng)險(xiǎn)APE組Qanadli栓塞指數(shù)(中位數(shù)31.25%)大于非高危APE組(中位數(shù)10.00%)。三組患者間各右心功能參數(shù)在總體間均存在統(tǒng)計(jì)學(xué)差異，其中RVEDV、RVEDV/LVEDV、RVESV、RVESV/LVESV、RVd4CH/LVd4CH分別在三組患者間兩兩比較具有統(tǒng)計(jì)學(xué)差異。高風(fēng)險(xiǎn)組及非高風(fēng)險(xiǎn)組總體肺動(dòng)脈栓塞指數(shù)與右心功能計(jì)量參數(shù)間均存在不同程度輕至中度相關(guān)關(guān)系（rs=0.194~0.503），其中RVSV、RVEF與Qanadli栓塞指數(shù)間呈負(fù)相關(guān)關(guān)系（rs=-0.400~-0.360）；高風(fēng)險(xiǎn)組各右心計(jì)量指標(biāo)與栓塞指數(shù)間存在輕至中度相關(guān)關(guān)系；非高風(fēng)險(xiǎn)組右心功能計(jì)量指標(biāo)與栓塞指數(shù)間呈輕度相關(guān)關(guān)系，，其中肺動(dòng)脈主干寬度、主肺動(dòng)脈直徑比、上腔靜脈短徑以及奇靜脈短徑在非高風(fēng)險(xiǎn)組P＞0.05，差異無統(tǒng)計(jì)學(xué)意義。Qanadli栓塞指數(shù)、RVEDV、RVEDV/LVEDV、RVESV、RVESV/LVESV、RVEF、RVd4CH、RVd4CH/LVd4CH、Daz的ROC曲線下面積均大于0.5，其中RVESV/LVESV的Az值最大，為0.977。 結(jié)論回顧性心電門控CTPA可用于APE患者疾病嚴(yán)重程度的評(píng)價(jià)，為臨床APE患者病情的正確評(píng)估、治療方案的選擇與調(diào)整以及預(yù)后的預(yù)測評(píng)價(jià)提供影像學(xué)依據(jù)。
[Abstract]:Objective to investigate the clinical value of retrospective ECG gated CTPACT embolism index and cardiovascular parameters in evaluating the severity of APE patients. Methods 65 patients undergoing ECG gated CTPA were divided into high risk APE group (n = 20), non-high risk group (n = 25) and control group (n = 20) according to the serious risk degree of ECG. Comparison and analysis of Qanadli embolic index between two groups and right ventricular end-diastolic volume RVEDV, end-systolic volume RVESV, right left ventricular end-diastolic volume RVESV, right ventricular end-diastolic volume compared with RVESV/LVESV, right ventricular stroke volume RVSV, right ventricular ejection fraction RVEF, Right ventricular maximum short diameter RVd4CH, right left ventricular maximum short diameter ratio RVd4CH/LVd4CH, main pulmonary artery diameter ratio, superior vena cava and azygos vein short diameter, interventricular septum morphology and inferior vena cava contrast agent reflux. The relationship between CT embolism index and right ventricular morphological function parameters was analyzed by spearman grade correlation analysis. The accuracy, sensitivity and specificity of each parameter obtained by retrospective ECG gated CTPA in the diagnosis of APE severity were determined by ROC curve. Results the Qanadli embolism index of high risk APE group (median 31.25%) was higher than that of non-high risk APE group (median 10.00%). There were significant differences in right ventricular function parameters among the three groups, and RVEDV,RVEDV/LVEDV,RVESV,RVESV/LVESV,RVd4CH/LVd4CH was significantly different among the three groups. There was a mild to moderate correlation between the total pulmonary embolism index and the measurement parameters of right ventricular function in high risk group and non-high risk group (rs=0.194~0.503). Among them, RVSV, was found to be mild to moderate. There was a negative correlation between RVEF and Qanadli embolism index (rs=-0.400~-0.360). There was a mild to moderate correlation between the right heart measurement index and the embolism index in the high risk group. There was a slight correlation between the measurement index of right ventricular function and embolism index in the non-high risk group, in which the width of the main pulmonary artery, the ratio of the diameter of the main pulmonary artery, the short diameter of the superior vena cava and the short diameter of azygos vein were significantly higher than those in the non-high risk group (P > 0.05). There was no significant difference. Qanadli embolism index, the area under the ROC curve of RVEDV,RVEDV/LVEDV,RVESV,RVESV/LVESV,RVEF,RVd4CH,RVd4CH/LVd4CH,Daz was more than 0.5, among which the Aze value of RVESV/LVESV was the largest (0.977). Conclusion retrospective ECG gated CTPA can be used to evaluate the severity of APE patients, and provide imaging basis for the correct evaluation of clinical APE patients, the selection and adjustment of treatment schemes and the prediction and evaluation of prognosis.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R563.5;R816.41

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