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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 593 -599. doi: 10.3877/cma.j.issn.1674-6902.2026.04.010

论著

肺动脉造影测定肺动脉扩张性在急性肺栓塞患者风险分层中的应用研究
王倩1, 韩星2, 朱宁1, 陈雷1, 张耐3,†()   
  1. 1221006　徐州，徐州医科大学第二附属医院呼吸与危重症医学科
    2221006　徐州，徐州医科大学第二附属医院医学影像科
    3221006　徐州，徐州医科大学第二附属医院介入放射科
  • 收稿日期:2026-03-25 出版日期:2026-08-25
  • 通信作者: 张耐
  • 基金资助:
    徐州市科技局卫生健康面上项目(KC25093)

Application of pulmonary arterial distensibility measured by pulmonary angiography in risk stratification of patients with acute pulmonary embolism

Qian Wang1, Xing Han2, Ning Zhu1, Lei Chen1, Nai Zhang3,†()   

  1. 1Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
    2Department of Medical Imaging, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
    3Department of Interventional Radiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
  • Received:2026-03-25 Published:2026-08-25
  • Corresponding author: Nai Zhang
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引用本文：

王倩, 韩星, 朱宁, 陈雷, 张耐. 肺动脉造影测定肺动脉扩张性在急性肺栓塞患者风险分层中的应用研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 593-599.

Qian Wang, Xing Han, Ning Zhu, Lei Chen, Nai Zhang. Application of pulmonary arterial distensibility measured by pulmonary angiography in risk stratification of patients with acute pulmonary embolism[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 593-599.

目的

探讨心电图门控计算机断层肺动脉造影(computed tomography pulmonary angiography, CTPA)监测肺动脉扩张性(pulmonary artery distensibility, PAD)在急性肺栓塞(acute pulmonary embolism, APE)患者风险分层中的临床意义。

方法

选择2021年2月至2025年12月我院收治的接受心电图门控CTPA检查APE患者109例。根据预后情况分组，预后不佳23例为观察组，预后良好86例为对照组。比较两组超敏心肌肌钙蛋白I(high-sensitivity cardiac troponin I, hs-cTnI)、D二聚体、N末端B型利钠肽前体(N-terminal pro-B-type natriuretic peptide, NT-proBNP)，计算简化肺栓塞严重程度指数(simplified pulmonary embolism severity index, sPESI)、简化Wells评分及肺栓塞排除标准(pulmonary embolism rule-out criteria, PERC)评分。CTPA检测右心室/左心室横径比值(right ventricle/left ventricle ratio, RV/LV)、肺动脉阻塞指数(pulmonary artery obstruction index, PAOI)及PAD。采用受试者特征工作曲线(receiver operating characteristic, ROC)预测；通过多因素Logistic回归分析预后危险因素，构建列线图。

结果

观察组与对照组比较，血清hs-cTnI[96.50(28.79，269.32)pg/ml比43.85(24.22，90.76)pg/ml]、NT-proBNP[2 147.00(422.05，5 687.15)pg/ml比140.60(45.21，614.20)pg/ml]、sPESI[2.00(1.00，3.00)分比1.00(0.00，1.00)分]及PERC评分[2.00(2.00，3.00)分比1.00(1.00，2.00)分]升高，收缩压[135.50(119.75，150.25)mmHg比139.50(124.50，150.00)mmHg]降低(P<0.05)。观察组RV/LV[1.33(1.08，1.56)比0.95(0.90，1.15)]、RV/LV>1.0者占比(89.66%比49.65%)及PAOI[35.25%(31.03%，40.73%)比29.00%(25.93%，34.23%)]高于对照组，PAD降低[2.95(2.22，4.97)×10－3/mmHg比5.98(4.37，7.31)×10－3/mmHg](P<0.05)。ROC曲线分析显示，PAD预测短期预后不佳的曲线下面积(area under the curve, AUC)为0.859(95%CI：0.803~0.904)，敏感度84.48%，特异度80.14%；RV/LV AUC为0.757(95%CI：0.691~0.815)，截断值>1.0时敏感度89.66%、特异度54.61%；PAOI AUC为0.766(95%CI：0.700~0.823)，截断值>30%时敏感度84.48%、特异度70.21%。多因素Logistic回归显示，NT-proBNP>125 pg/ml(OR＝5.396，95%CI：1.822~15.978)、RV/LV>1.0(OR＝7.562，95%CI：2.397~23.860)、PAOI>30%(OR＝13.784，95%CI：3.912~48.567)及PAD>4.28×10－3/mmHg(OR＝0.086，95%CI：0.028~0.270)为APE预后的危险因素(P<0.05)。联合预测AUC为0.94(95%CI：0.90~0.98)，优于单一指标(P<0.05)。

结论

心电图门控CTPA监测PAD反映APE患者肺血管力学改变，预测优于RV/LV和PAOI。PAD、RV/LV、PAOI及NT-proBNP联合预测可提高APE患者风险分层准确性，具有临床意义。

关键词: 急性肺栓塞, 计算机断层肺动脉造影, 肺动脉扩张性, 右心室功能, 预后
Objective

To investigate the clinical significance of pulmonary artery distensibility (PAD) monitored by electrocardiogram-gated computed tomography pulmonary angiography (CTPA) in the prognostic risk stratification of patients with acute pulmonary embolism (APE).

Methods

A total of 109 APE patients who underwent electrocardiogram-gated CTPA in our hospital from February 2021 to December 2025 were enrolled. According to the prognosis, 23 patients with poor prognosis were assigned to the observation group and 86 patients with good prognosis to the control group. Serum high-sensitivity cardiac troponin I (hs-cTnI), D-dimer, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were compared between the two groups. The simplified Pulmonary Embolism Severity Index (sPESI), simplified Wells score, and Pulmonary Embolism Rule-out Criteria (PERC) score were calculated. The right ventricle/left ventricle transverse diameter ratio (RV/LV), pulmonary artery obstruction index (PAOI), and PAD were measured by CTPA. The predictive value was assessed by receiver operating characteristic (ROC) curves. Multivariate logistic regression analysis was used to identify prognostic risk factors, and a nomogram model was constructed.

Results

Compared with the control group, the observation group showed significantly higher serum hs-cTnI[96.50 (28.79, 269.32) pg/ml vs. 43.85 (24.22, 90.76) pg/ml], NT-proBNP [2 147.00 (422.05, 5 687.15) pg/ml vs. 140.60 (45.21, 614.20) pg/ml], sPESI [2.00(1.00, 3.00) points vs. 1.00(0.00, 1.00) points], and PERC score [2.00(2.00, 3.00) points vs. 1.00(1.00, 2.00) points], and lower systolic blood pressure [135.50 (119.75, 150.25) mmHg vs. 139.50 (124.50, 150.00) mmHg] (P<0.05). The observation group also had higher RV/LV [1.33 (1.08, 1.56) vs. 0.95 (0.90, 1.15)], a higher proportion of RV/LV>1.0 (89.66% vs. 49.65%), and higher PAOI [35.25% (31.03%, 40.73%) vs. 29.00% (25.93%, 34.23%)], while PAD was significantly lower [2.95 (2.22, 4.97)×10-3/mmHg vs. 5.98(4.37, 7.31)×10-3/mmHg] (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of PAD for predicting poor short-term prognosis was 0.859 [95%CI: 0.803~0.904], with a sensitivity of 84.48% and a specificity of 80.14%. The AUC of RV/LV was 0.757 (95%CI: 0.691~0.815), with a sensitivity of 89.66% and a specificity of 54.61% at the cutoff value>1.0. The AUC of PAOI was 0.766 (95%CI: 0.700~0.823), with a sensitivity of 84.48% and a specificity of 70.21% at the cutoff value >30%. Multivariate logistic regression analysis revealed that NT-proBNP>125 pg/ml (OR=5.396, 95%CI: 1.822~15.978), RV/LV>1.0 (OR=7.562, 95%CI: 2.397~23.860), PAOI>30% (OR=13.784, 95%CI: 3.912~48.567), and PAD>4.28×10-3/mmHg (OR=0.086, 95%CI: 0.028~0.270) were risk factors for the prognosis of APE (P<0.05). The AUC of the combined prediction was 0.94 (95%CI: 0.90~0.98), which was superior to that of any single indicator (P<0.05).

Conclusion

PAD measured by electrocardiogram-gated CTPA can reflect the mechanical changes of pulmonary vasculature in APE patients, and its predictive performance is superior to RV/LV and PAOI. The combination of PAD, RV/LV, PAOI, and NT-proBNP can improve the accuracy of risk stratification in APE patients, demonstrating clinical significance.

Key words: Acute pulmonary embolism, Computed tomography pulmonary angiography, Pulmonary artery distensibility, Right ventricular function, Prognosis
图1 CTPA肺动脉截面积监测图。图A为轴向图像，箭头指向右心室与左心室所在心腔层面；图B为矢状面图像，辅助定位指向主肺动脉长轴走行区域；图C为舒张期冠状位，箭头所指为主肺动脉横断层面，进行最大横截面积测量；图D为收缩期冠状位，箭头所指为主肺动脉的横断层面，进行最小横截面积测量
表1 两组急性肺栓塞患者临床资料结果
临床资料 观察组(n＝23) 对照组(n＝86) t/χ2/Z值 P值
主诉[n(%)]        
咯血 2(8.70) 4(4.65) 0.571 0.450
胸痛 4(17.39) 14(16.28) 0.016 0.899
晕厥 1(4.35) 3(3.49) 0.185 0.668
腿疼 2(8.70) 3(3.49) 1.124 0.289
下肢肿胀 1(4.35) 2(2.33) 0.036 0.849
腹痛/腹胀 2(8.70) 5(5.91) 0.251 0.617
生命体征[M50(Q1，Q3)]        
收缩压(mmHg) 135.50(119.75，150.25) 139.50(124.50，150.00) －3.336 0.000
舒张压(mmHg) 80.00(70.00，89.00) 81.00(78.75，90.00) －1.084 0.302
平均动脉压(mmHg) 98.00(88.50，107.00) 100.50(95.50，110.50) －0.968 0.333
血氧饱和度(%) 93.50(88.00，96.00) 95.00(92.00，97.00) －0.455 0.649
实验室检查[M50(Q1，Q3)]        
hs-cTnI(pg/ml) 96.50(28.79，269.32) 43.85(24.22，90.76) －2.921 0.009
D-二聚体(ng/ml) 18.28(5.69，180.71) 19.14(4.32，564.50) －0.246 0.805
NT-proBNP(pg/ml) 2 147.00(422.05，5 687.15) 140.60(45.21，614.20) －6.762 0.000
评分[M50(Q1，Q3)]        
sPESI(分) 2.00(1.00，3.00) 1.00(0.00，1.00) －4.891 0.000
简化Wells评分(分) 2.00(1.00，3.00) 1.00(0.00，3.00) －1.290 0.197
PERC评分(分) 2.00(2.00，3.00) 1.00(1.00，2.00) －2.337 0.019
表2 两组APE患者CTPA参数比较
CTPA参数 观察组(n＝23) 对照组(n＝86) χ2/Z值 P值
中央型肺栓塞[n(%)] 11(47.83) 18(20.93) 6.723 0.010
RV/LV[M50(Q1，Q3)] 1.33(1.08，1.56) 0.95(0.90，1.15) －5.688 0.000
RV/LV>1.0[n(%)] 20(86.96) 39(45.35) 12.65 0.000
PAOI[%，M50(Q1，Q3)] 35.25(31.03，40.73) 29.00(25.93，34.23) －5.882 0.000
PAD[×10－3/mmHg，M50(Q1，Q3)] 2.95(2.22，4.97) 5.98(4.37，7.31) －7.950 0.000
图2 APE预后不良风险预测列线图
表3 APE预后危险因素多因素Logistic回归分析
自变量 b SE(b) Walds值 OR(95%CI) P值
收缩压(每增加10 mmHg) －0.012 0.011 1.140 0.988(0.966~1.010) 0.286
hs-cTnI>52 pg/ml 0.998 0.604 2.727 2.712(0.830~8.865) 0.099
NT-proBNP>125 pg/ml 1.686 0.554 9.263 5.396(1.822~15.978) 0.002
sPESI>1分 0.921 0.638 2.087 2.512(0.720~8.763) 0.149
PERC评分>2分 0.188 0.596 0.099 1.207(0.375~3.881) 0.753
RV/LV比值>1.0 2.023 0.586 11.908 7.562(2.397~23.860) 0.000
PAOI>30% 2.624 0.643 16.670 13.784(3.912~48.567) 0.000
PAD>4.28×10－3/mmHg －2.451 0.582 17.720 0.086(0.028~0.270) 0.000
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