摘要
目的 探讨胸部CT影像征象对高原地区急性肺动脉栓塞(APE)危险分层的预测价值.方法 回顾性选取首次确诊APE的患者202例,根据临床危险分层标准,将所有患者分为低危组(104例)及中/高危组(98例).收集患者的人口学特征及胸部CT影像参数,包括性别、年龄、升主动脉直径(AAd)、主肺动脉直径(MPAd)、主肺动脉直径与升主动脉直径之比(r PA)、肺动脉栓塞指数(PAOI)、PAOI分级、肺气肿、膨胀不全、肺实变、胸腔积液、心包积液及肺不张.对2组间各参数进行比较及统计学分析.结果 2组间年龄、MPAd、r PA、PAOI分级、肺气肿及心包积液差异有统计学意义(P<0.05),性别、AAd、PAOI、膨胀不全、肺实变、胸腔积液及肺不张无统计学差异(P>0.05).logistic回归分析显示年龄、r PA、PAOI分级及心包积液是APE危险分层的独立影响因素,受试者工作特征(ROC)曲线分析显示,曲线下面积(AUC)分别为0.654,0.699,0.669和0.616,四者联合的AUC为0.843,敏感度为76.5%,特异度为77.9%.结论 胸部CT影像征象r PA、PAOI分级、心包积液联合患者年龄对高原地区APE危险分层具有重要预测价值.
Abstract
Objective To investigate the predictive value of chest CT imaging characteristics for risk stratification of acute pulmo-nary embolism(APE)in the plateau area.Methods A total of 202 patients diagnosed with APE for the first time were retrospec-tively selected.According to clinical risk stratification criteria,all patients were categorized into low-risk group(104 cases)and medium/high-risk group(98 cases).Demographic characteristics and chest CT image parameters of patients were collected,including gender,age,ascending aorta diameter(AAd),main pulmonary artery diameter(MPAd),the ratio of main pulmonary artery diameter to ascend-ing aorta diameter(r PA),pulmonary artery obstruction index(PAOI),PAOI grade,emphysema,atelectasis,pulmonary consolida-tion,pleural effusion,pericardial effusion,and pulmonary atelectasis.All these parameters between the two groups were compared and statistically analyzed.Results There was a statistically significant difference between the two groups in age,MPAd,r PA,PAOI grade,emphysema,and pericardial effusion(P<0.05).No statistically significant difference was showed in gender,AAd,PAOI,ate-lectasis,pulmonary consolidation,pleural effusion,and pulmonary atelectasis between the two groups(P>0.05).The logistic regres-sion analysis showed that age,r PA,PAOI grade,and pericardial effusion were independent factors for risk stratification of APE.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was 0.654,0.699,0.669,and 0.616,respectively.The combined AUC was 0.843,with a sensitivity of 76.5%and a specificity of 77.9%.Conclusion Chest CT imaging characteris-tics such as r PA,PAOI grade,and pericardial effusion combined with patient age have important predictive value for risk stratification of APE in the plateau area.
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