Correlation between Pulmonary Artery Diameter by HRCT and Pulmonary Artery Pressure by Echocardiography in Patients with Chronic Obstructive Pulmonary Disease
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摘要:
目的 研究慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者高分辨率计算机断层扫描（high resolution computedtomography，HRCT）检查肺动脉直径测量值与超声心动图检查肺动脉压数值的相关性，找到一种新的方法评估肺动脉压，为临床评估病情增加新的方法。 方法 将昆明市第一人民医院2018年5月至2020年5月就诊的77例慢阻肺患者设为试验组，另选同期在昆明市第一人民医院进行健康体检的50例健康者设为对照组，均行胸部HRCT检查测量右侧肺动脉直径、左侧肺动脉直径、肺动脉主干直径，同时行心脏彩超检查，测量右室内径、肺动脉压、主肺动脉内径，将收集数据进行相关性分析。 结果 COPD组HRCT检查左、右肺动脉直径、肺动脉主干直径数据均大于正常人组（P < 0.05），且COPD各组之间右肺动脉直径、肺动脉主干直径数据存在差异（P < 0.05），而左侧肺动脉直径不存在差异（P > 0.05）；COPD各组之间超声心动图检查测定右室内径、肺动脉压数值存在差异（P < 0.05），而主肺动脉内径不存在差异（P > 0.05）；经Pearson直线相关性分析右室内径、肺动脉压、主肺动脉内径测定值与左、右肺动脉直径、肺动脉主干直径数据有明显相关性（P < 0.05），且均为正相关。 结论 COPD患者肺动脉压数值与肺动脉直径数值有明显相关性，HRCT测量肺动脉主干直径、右肺动脉直径可作为评估肺动脉压的一种方法。 -
关键词:
- 慢性阻塞性肺疾病 /
- 高分辨率计算机断层扫描 /
- 心脏彩超 /
- 肺动脉压
Abstract:Objective The correlation between pulmonary artery diameter measured by high resolution computedtomography （HRCT） and pulmonary artery pressure measured by echocardiography in patients with chronic obstructive pulmonary disease （COPD） was investigated to find a new method to assess pulmonary artery pressure and to add a new method to the clinical assessment of the disease. Methods Seventy-seven patients with stable chronic obstructive pulmonary disease who were seen in Kunming First People’ s Hospital from May 2018 to May 2020 were set as the test group, and 50 healthy individuals who underwent health checkups in same period were selected as the control group, all of whom underwent chest HRCT to measure right pulmonary artery diameter, left pulmonary artery diameter, and main pulmonary artery diameter, and also underwent cardiac ultrasound to measure right ventricular diameter, pulmonary artery pressure, and main pulmonary artery diameter. The data collected were analyzed for correlation. Results The data of left and right pulmonary artery diameter and main pulmonary artery diameter measured by HRCT in the COPD group were larger than those in the normal group （P < 0.05）, and there were differences in the data of right pulmonary artery diameter and main pulmonary artery diameter between the COPD groups （P < 0.05）, but not in the left pulmonary artery diameter （P > 0.05）; the right intraventricular diameter and pulmonary artery pressure measured by echocardiography were different between the COPD groups （P < 0.05）. The right intraventricular diameter, pulmonary artery pressure, and main pulmonary artery diameter were significantly correlated with the left and right pulmonary artery diameters and main pulmonary artery diameter by Pearson linear correlation analysis （P < 0.05）, and all were positively correlated. Conclusio There is a significant correlation between the values of pulmonary artery pressure and the values of pulmonary artery diameter in patients with COPD. HRCT measurement of pulmonary artery trunk diameter and right pulmonary artery diameter can be used as a method to assess pulmonary artery pressure. -
表 1 COPD组与对照组之间的肺动脉直径比较（
$\bar x \pm s$ ）Table 1. Comparison of pulmonary artery diameter between COPD and normal subjects groups （
$\bar x \pm s$ ）组别 n 左侧肺动脉直径（mm） 右侧肺动脉直径（mm） 肺动脉主干直径（mm） COPD组 77 20.36 ± 3.63 22.08 ± 4.39 28.96 ± 5.60 对照组 50 15.21 ± 2.32 15.76 ± 1.97 21.52 ± 3.03 t 9.758 11.040 9.680 P < 0.001* < 0.001* < 0.001* *P < 0.05。 
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表 2 COPD各组之间肺动脉直径比较（
$\bar x \pm s$ ）Table 2. Comparison of pulmonary artery diameter between COPD groups （
$\bar x \pm s$ ）组别 n 左侧肺动脉直径（mm） 右侧肺动脉直径（mm） 肺动脉主干直径（mm） 轻度组 8 19.63 ± 3.50 20.63 ± 3.46 27.21 ± 5.53 中度组 23 19.60 ± 2. 45 20.67 ± 3.52 27.03 ± 4.01 重度组 18 19.61 ± 3.67 20.85 ± 3.93 27.62 ± 5.56 极重度组 28 21.69 ± 4.21 24.45 ± 4.71 31.92 ± 5.79 t 2.032 4.946 4.710 P 0.117 0.004* 0.005* *P < 0.05。
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表 3 COPD各组之间心脏相关数值比较（
$\bar x \pm s$ ）Table 3. Comparison of cardiac-related values between COPD groups （
$\bar x \pm s$ ）组别 n 右室内径（mm） 肺动脉压（mmHg） 主肺动脉内径（mm） 轻度组 8 26.75 ± 2.92 32.25 ± 7.40 22.63 ± 1.20 中度组 23 28.13 ± 3.24 38.85 ± 12.64 24.13 ± 1.79 重度组 18 26.83 ± 2.50 42.24 ± 11.41 23.67 ± 2.54 极重度组 28 30.36 ± 4.10 53.22 ± 22.61 24.86 ± 2.66 t 4.981 5.069 2.238 P 0.003* 0.005* 0.091 *P < 0.05。
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表 4 肺动脉直径与心脏相关数值相关性分析
Table 4. Correlation analysis of pulmonary artery diameter and heart-related values
组别 右室内径（mm） 肺动脉压（mmHg） 主肺动脉内径（mm） r P r P r P 左侧肺动脉直径（mm） 0.479 < 0.001* 0.505 < 0.001* 0.462 < 0.001* 右侧肺动脉直径（mm） 0.503 < 0.001* 0.458 < 0.001* 0.506 < 0.001* 肺动脉主干直径（mm） 0.444 < 0.001* 0.398 < 0.001* 0.478 < 0.001* *P < 0.05。
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[1] 任成山,钱桂生. 慢性阻塞性肺疾病发病机制研究现状与展望[J]. 中华肺部疾病杂志,2009,2(2):104-115. [2] Tan W C,Mahayiddin A A,Charoenratanakul S,et al. Global strategy for the diagnosis,Management and prevention of Chronic Obstructive Pulmonary Disease(UPDATE 2014)Global initiative for chronic obstructive lung disease 2014 GOLD[J]. Respirology,2005,10(1):9-17. doi: 10.1111/j.1440-1843.2005.00692.x [3] 陈刘通,廖晨,涂洪波,等. 吸烟及全身炎症反应与慢性阻塞性肺疾病患者中发生肺动脉高压的相关性研究[J]. 第三军医大学学报,2016,38(11):1293-1296. [4] 李清贤,徐建明. 超声心动图在肺栓塞诊断中的应用[J]. 包头医学,2019,43(2):24-25. doi: 10.3969/j.issn.1007-3507.2019.02.012 [5] 周媛凤,张颖,朱洁,等. 慢性阻塞性肺疾病肺血管重构防治研究[J]. 中医药临床杂志,2017,29(9):1367-1370. [6] 姜艳平,赵云峰,赵秋良. CT对慢性阻塞性肺疾病临床评估的价值[J]. 临床肺科杂志,2014,19(9):1684-1686. doi: 10.3969/j.issn.1009-6663.2014.09.045 [7] 王强,罗勇. 不同HRCT表型慢性阻塞性肺疾病患者呼吸功能和HRCT定量指标的对比研究[J]. 中国现代医学杂志,2020,30(13):62-66. doi: 10.3969/j.issn.1005-8982.2020.13.013 [8] Vestbo J,Hurd S S,Agusti P W,et al. Gloloal strategy for the diagnosis,management and prevention of chroic obstructive pulmonary disease:GOLD executive summary[J]. Am J Respir Crit Cave Med,2013,187(4):347-365. doi: 10.1164/rccm.201204-0596PP [9] 王超,许建英,武志峰,等. 慢性阻塞性肺疾病急性加重期患者 CT肺血管参数与病情严重程度的相关性研究[J]. 国际呼吸杂志,2019,39(7):515-520. doi: 10.3760/cma.j.issn.1673-436X.2019.07.008 [10] Matsuoka S,washko G R,Dransfield M T,et al. Quantitative CT measurement of cross-sectional area of small pulmonary vessel in COPD:con’ elation8 with emphysema and aimow limitation[J]. Acad Radiol,2010,17(1):93-99. doi: 10.1016/j.acra.2009.07.022 [11] 刘俊强. 慢性阻塞性肺疾病患者CT血管成像结果与肺功能参数、血气分析结果的相关性分析[J]. 中国卫生检验杂志,2018,28(3):313-316. [12] Chen X,Liu K,Wang Z,et a1. Computed tomography measurement of pulmonary artery for diagnosis of COPD and its comorbidity pulmonary hypertension[J]. Int J Chron Obstruct Pulmon Dis,2015,10(4):2525-2533. -
