多层螺旋CT心血管参数联合收缩压在肺动脉高压中的预测价值
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摘要
目的:探讨多层螺旋CT(MSCT)的心血管参数联合收缩压(SBP)对诊断肺动脉高压(PH)的预测价值。方法:回顾性分析84例经右心导管检查确诊为PH患者的MSCT心血管参数和临床记录。根据PH诊断标准分为实验组和对照组,比较2组患者的MSCT心血管参数和血压的差异性。按时间顺序,设前56例的数据为推导队列,推导多重线性回归模型,此方程基于主肺动脉与升主动脉直径的比值(rPA)、脊柱室间隔夹角(Septal angle)和SBP预测平均肺动脉压(MPAP)。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线比较这3个单因素与模型的诊断效能。后29例患者作为验证队列,用于进行前瞻性验证回归模型的准确性。结果:本研究推导的MPAP计算方程是:MPAP=9.011+34.195×rPA+0.402×Septal angle-0.319×SBP,其曲线下面积(AUC)为0.925,95%置信区间(CI)为0.848～1.000。与单独应用rPA、Septal angle、SBP相比,联合应用具有最高的预测价值。前瞻性验证中MPAP预测值与右心导管数值接近,其93.10%预测值的差值在95%一致性界限以内。结论:联合应用rPA、Septal angle、SBP有助于对PH进行评估,并为PH的临床治疗提供指导。
Objective:This study was aimed to investigate the predictive value of cardiovascular parameters of multi-slice spiral computed tomography(MSCT)scan and systolic blood pressure(SBP)in the diagnosis of pulmonary hypertension(PH).Method:A retrospective analysis of cardiovascular parameters of MSCT and clinical data was performed in 84 patients diagnosed as PH by right heart catheterization.The patients were divided into experimental group and control group according to the PH diagnostic criteria,and the differences in MSCT cardiovascular parameters and blood pressure between the two groups were compared.In chronological order,based on rPA,septal angle and SBP,a multiple linear regression equation was generated from the first 56 patients' data to estimate the mean pressure of pulmonary artery(MPAP).The ROC curve was used to compare the diagnostic efficiency a-mongst these three single factors and this model.The last 29 patients' data were used to test the accuracy of the model prospectively.Result:The computed equation for analyzing MPAP is MPAP=9.011+34.195×rPA+0.402×Septal angle-0.319×SBP.Its AUC was 0.925 with 95%CI(0.848-1.000).Compared with the use of rPA,septal angle and SBP individually,the combined use of them has the highest predictive value.The predicted value of MPAP in the validation cohort was close to that of right heart catheterization.Its subtraction was 93.10%in the95%limits of agreement.The difference of the predicted value of 93.10% was within the 95% consistency limit.Conclusion:The combined use of rPA,septal angle and SBP helps to evaluate PH and provides guidance for clinical treatment.
Objective:This study was aimed to investigate the predictive value of cardiovascular parameters of multi-slice spiral computed tomography(MSCT)scan and systolic blood pressure(SBP)in the diagnosis of pulmonary hypertension(PH).Method:A retrospective analysis of cardiovascular parameters of MSCT and clinical data was performed in 84 patients diagnosed as PH by right heart catheterization.The patients were divided into experimental group and control group according to the PH diagnostic criteria,and the differences in MSCT cardiovascular parameters and blood pressure between the two groups were compared.In chronological order,based on rPA,septal angle and SBP,a multiple linear regression equation was generated from the first 56 patients' data to estimate the mean pressure of pulmonary artery(MPAP).The ROC curve was used to compare the diagnostic efficiency a-mongst these three single factors and this model.The last 29 patients' data were used to test the accuracy of the model prospectively.Result:The computed equation for analyzing MPAP is MPAP=9.011+34.195×rPA+0.402×Septal angle-0.319×SBP.Its AUC was 0.925 with 95%CI(0.848-1.000).Compared with the use of rPA,septal angle and SBP individually,the combined use of them has the highest predictive value.The predicted value of MPAP in the validation cohort was close to that of right heart catheterization.Its subtraction was 93.10%in the95%limits of agreement.The difference of the predicted value of 93.10% was within the 95% consistency limit.Conclusion:The combined use of rPA,septal angle and SBP helps to evaluate PH and provides guidance for clinical treatment.
引文
[1] 徐希奇,荆志成.第六届世界肺高血压会议:聚焦肺高血压定义与诊断分类更新[J].协和医学杂志,2018,9(3):197-201.
[2] 张振宁,王勇,潘磊,等.肺动脉高压患者经左前臂行标准右心导管检查科学性的探讨[J].临床心血管病杂志,2011,27(1):39-41.
[3] Galie N,Humbert M,Vachiery JL,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension:The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society(ERS):Endorsed by:Association for European Paediatric and Congenital Cardiology(AEPC),International Society for Heart and Lung Transplantation(ISHLT)[J].Eur Respir J,2016,37(1):67-119.
[4] Wells JM,Washko GR,Han MK,et al.Pulmonary arterial enlargement and acute exacerbations of COPD[J].N Engl J Med,2012,367(10):913-921.
[5] 谢万木,黄可,张泽宇,等.ESC/ERS《肺动脉高压诊断和治疗指南》解读之定义和分[J].中华医学杂志,2016,96(10):827-829.
[6] Badesch DB,Champion HC,Sanchez MA,et al.Diagnosis and assessment of pulmonary arterial hypertension[J].J Am Coll Cardiol,2009,54(1 Suppl):S55-S66.
[7] Rich JD,Shah SJ,Swamy RS,et al.Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension:implications for clinical practice[J].Chest,2011,139(5):988-993.
[8] Fisher MR,Forfia PR,Chamera E,et al.Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension[J].Am J Respir Crit Care Med[J].2009,179(7):615-621.
[9] 张伟,俞同福,徐海,等.CT肺动脉成像对急性肺栓塞患者肺动脉高压严重程度的评估[J].放射学实践,2013,28(3):324-328.
[10] 唐春香,张龙江,卢光明.慢性血栓栓塞性肺动脉高压的CT研究与进展[J].国际医学放射学杂志,2012,35(3):233-236.
[11] 刘敏,马展鸿,郭晓娟,等.CT肺动脉造影测定脊柱室间隔角评价慢性血栓栓塞性肺动脉高压肺血管阻力的价值探讨[J].中国呼吸与危重监护杂志,2012,11(4):382-386.
[12] Liu M,Ma ZH,Guo XJ,et al.A septal angle measured on computed tomographic pulmonary angiography can noninvasively estimate pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension[J].J Thorac Imaging,2012,27(5):325-330.
[13] 林雅慧,祖秀光,张秀娟.慢性心力衰竭患者入院血压水平对心源性死亡的判断价值[J].临床心血管病杂志,2018,34(5):489-493.
[2] 张振宁,王勇,潘磊,等.肺动脉高压患者经左前臂行标准右心导管检查科学性的探讨[J].临床心血管病杂志,2011,27(1):39-41.
[3] Galie N,Humbert M,Vachiery JL,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension:The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society(ERS):Endorsed by:Association for European Paediatric and Congenital Cardiology(AEPC),International Society for Heart and Lung Transplantation(ISHLT)[J].Eur Respir J,2016,37(1):67-119.
[4] Wells JM,Washko GR,Han MK,et al.Pulmonary arterial enlargement and acute exacerbations of COPD[J].N Engl J Med,2012,367(10):913-921.
[5] 谢万木,黄可,张泽宇,等.ESC/ERS《肺动脉高压诊断和治疗指南》解读之定义和分[J].中华医学杂志,2016,96(10):827-829.
[6] Badesch DB,Champion HC,Sanchez MA,et al.Diagnosis and assessment of pulmonary arterial hypertension[J].J Am Coll Cardiol,2009,54(1 Suppl):S55-S66.
[7] Rich JD,Shah SJ,Swamy RS,et al.Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension:implications for clinical practice[J].Chest,2011,139(5):988-993.
[8] Fisher MR,Forfia PR,Chamera E,et al.Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension[J].Am J Respir Crit Care Med[J].2009,179(7):615-621.
[9] 张伟,俞同福,徐海,等.CT肺动脉成像对急性肺栓塞患者肺动脉高压严重程度的评估[J].放射学实践,2013,28(3):324-328.
[10] 唐春香,张龙江,卢光明.慢性血栓栓塞性肺动脉高压的CT研究与进展[J].国际医学放射学杂志,2012,35(3):233-236.
[11] 刘敏,马展鸿,郭晓娟,等.CT肺动脉造影测定脊柱室间隔角评价慢性血栓栓塞性肺动脉高压肺血管阻力的价值探讨[J].中国呼吸与危重监护杂志,2012,11(4):382-386.
[12] Liu M,Ma ZH,Guo XJ,et al.A septal angle measured on computed tomographic pulmonary angiography can noninvasively estimate pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension[J].J Thorac Imaging,2012,27(5):325-330.
[13] 林雅慧,祖秀光,张秀娟.慢性心力衰竭患者入院血压水平对心源性死亡的判断价值[J].临床心血管病杂志,2018,34(5):489-493.