RVv/LVv 和超声心动图在肺动脉 高压诊断中的价值

Right ventricular volume to left ventricular volume ratio and echocardiography in diagnosis of pulmonary hypertension

摘要:

目的 探讨胸部CT 的右心室、左心室容积比（RVv/LVv）和超声心动图（UCG）的肺动脉 收缩压（PASP）在肺动脉高压（PAH）诊断中的价值。方法 回顾性分析2015 年2 月-2017 年7 月在该 院初诊的136 例疑似PAH 患者的临床资料，以右心导管检查（RHC）结果为金标准，比较RVv/LVv 及 PASPUCG 在PAH 诊断中的准确率。结果 136 例疑似PAH 患者中，102 例为PAH 患者，34 例为非PAH 患 者。两组PASPRHC、RVv/LVv 比较，差异有统计学意义（P <0.05），RVv/LVv、PASPUCG 与PASPRHC 呈正相 关（P <0.05），采用受试者工作特征曲线获得RVv/LVv、PASPUCG 最佳临界值（0.86、40 mmHg）。若以此为 分组依据，RVv/LVv 的诊断敏感性、特异性、准确率分别为89.4%（95%CI ：81.4%，94.3%）、88.2%（95%CI ： 71.6%，96.2%）和89.0%（95%CI ：80.2%，95.7%）；PASPUCG 为91.1%（95%CI ：83.5%，95.6%）、85.3%（95%CI ： 68.2%，94.5%）和89.7%（95%CI ：85.6%，97.2%）；两者联用为98.0%（95%CI ：92.4%，99.7%）、85.3%（95%CI ： 68.2%，94.5%）和94.9%（95%CI ：88.9%，98.9%）。结论 RVv/LVv、PASPUCG 在PAH 早期诊断中有较好的诊 断效能，若两者联合可进一步提高诊断准确率。

Abstract:

Objective To investigate the clinical value of right ventricular to left ventricular volume ratio (RVv/LVv) and echocardiographic (UCG) pulmonary artery systolic pressure (PASP) in the diagnosis of pulmonary artery hypertension (PAH). Methods A retrospective analysis was conducted on 136 patients of suspected PAH newly diagnosed in our hospital from February 2015 to July 2017. Taking the results of right heart catheterization (RHC) as the gold standard of diagnosis, the accuracy of RVv/LVv and PASPUCG in PAH diagnosis was observed. Results Among the 136 suspected PAH patients, 102 were PAH patients and 34 were non-PAH patients. There were significant differences in PASPRHC and RVv/LVv between the two groups (P < 0.05), while RVv/LVv and PASPUCG were positively associated with PASPRHC (P < 0.05). The best critical values of RVv/LVv and PASPUCG obtained by ROC were 0.86 and 40 mmHg respectively. The diagnostic sensitivity, specificity and accuracy of RVv/LVv were 89.4% (95% CI: 0.814, 0.943), 88.2% (95% CI: 0.716, 0.962) and 89.0% (95% CI: 0.802, 0.957), respectively; those of PASPUCG were 91.1% (95% CI: 0.835, 0.956), 85.3% (95% CI: 0.682, 0.945) and 89.7% (95% CI: 0.856, 0.972) respectively; and those of the combination of the two were 98.0% (95% CI: 0.924, 0.997), 85.3% (95% CI: 0.682, 0.945) and 94.9% (95% CI: 0.889, 0.989) respectively. Conclusions RVv/LVv and PASPUCG have better diagnostic efficacy in the early diagnosis of pulmonary hypertension, their combination can further improve the diagnostic accuracy.