MSCT诊断慢性阻塞性肺疾病合并慢性肺源性心脏病

目的 比较不同严重程度慢性阻塞性肺疾病（COPD）及COPD合并慢性肺源性心脏病患者右心室功能，评价MSCT诊断COPD合并慢性肺源性心脏病的价值。方法 对53例COPD患者（轻中度组13例、重度组22例及合并慢性肺源性心脏病组18例）和36名健康志愿者（对照组）行肺功能和MSCT检查。记录肺功能和右心室功能参数。比较各组右心室功能差异，分析COPD患者肺功能与右心室功能的相关性。分别绘制右心室每搏输出量（SV）、射血分数（EF）的ROC曲线，评价MSCT在COPD合并慢性肺源性心脏病中的诊断价值。以预试验确定的右心室SV<48 ml或EF<40%作为诊断慢性肺源性心脏病的标准，计算诊断敏感度和特异度。结果 4组间右心室舒张末容积（EDV）、EDV/体质量指数（BMI）、SV、SV/BMI及EF差异有统计学意义（P均<0.05），而收缩末容积（ESV）及ESV/BMI差异无统计学意义（P均>0.05）。COPD患者右心室SV/BMI、EF与第1秒用力呼气容积（FEV1）（r=0.321、0.296，P=0.019、0.031）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）（r=0.305、0.280，P=0.026、0.043）及FEV1占预计值百分比（FEV1%_pred；r=0.457、0.351，P=0.001、0.001）均呈正相关。分别绘制右心室EF、SV ROC曲线，AUC分别为0.973、0.930（P均<0.001），MSCT诊断慢性肺源性心脏病的敏感度分别为77.77%、77.77%，特异度分别为98.59%、88.63%。结论 COPD患者在未达到慢性肺源性心脏病诊断标准前右心室功能已出现减退，且其肺功能与右心室功能呈正相关。MSCT能早期发现COPD患者右心室功能不全，且对于诊断慢性肺源性心脏病具有重要价值。

MSCT in diagnosis of chronic obstructive pulmonary disease accompanied with chronic pulmonary heart disease

Objective To compare the right ventricular function in patients with different severities of chronic pulmonary heart disease (COPD) and COPD accompanied with chronic pulmonary heart disease, and to evaluate the value of MSCT in diagnosis of COPD accompanied with chronic pulmonary heart disease. Methods MSCT was performed in 53 patients with COPD (13 patients in mild to moderate group, 22 patients in severe group and 18 patients in COPD accompanied with chronic pulmonary heart disease group) and 36 healthy volunteers (control group). Pulmonary function and right ventricular function parameters were recorded. The differences of right ventricular function were compared among four groups. The correlation between right ventricular function and pulmonary function were analyzed. ROC curves of right ventricle ejection fraction (EF) and stroke volume (SV) were constructed to assess the value of MSCT in diagnosis of COPD accompanied with pulmonary heart disease. The sensitivity and specificity were evaluated with EF<40% or SV<48 ml determined by pre-experiment as the diagnostic criteria for pulmonary heart disease. Results The differences of right ventricular end-diastolic volume (EDV), EDV/body mass index (BMI), SV, SV/BMI and EF were statistically significant among 4 groups (all P<0.05). There was no significant difference of end-systolic volume (ESV) and ESV/BMI (all P>0.05). There were positive correlations between SV/BMI, EF and forced expiratory volume in one second (FEV1; r=0.321, 0.296, P=0.019, 0.031), FEV1/forced vital capacity (FVC; r=0.305, 0.280; P=0.026, 0.043) and percentage of predicted value of the FEV1(FEV1%_pred; r=0.457, 0.351, P=0.001, 0.001). ROC curves of right ventricular EF and SV were drawn, and the AUC were 0.973 and 0.930 (both P<0.001), respectively. The sensitivity and specificity in diagnosis of chronic pulmonary heart disease were 77.77%, 77.77% and 98.59%, 88.63%, respectively. Conclusion Right ventricular function has already decreased in COPD patients before diagnosed with chronic pulmonary heart disease, which is positively correlated with pulmonary function. MSCT can not only detect right ventricular dysfunction in patients with COPD in early stage, but also have a great value in diagnosis of chronic pulmonary heart disease.