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

Abstract

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

CLC Number:

R563.5

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.

Figures/Tables 6

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

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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)

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