| Objective:To evaluate the severity of PE by quantitatively assessed the obstruction degree of pulmonary artery by using pulmonary artery CT obstruction index. The obstruction severity of pulmonary artery was assessed by the pulmonary artery CT obstruction index combined with blood gas values, Troponin I, D-dimer, plasma brain natriuretic peptide levels and right heart function indexes.Methods:In October2012to December2013, collected70patients which were suspected to have acute pulmonary embolism in the Second Affiliated Hospital of Kunming Medical University as the experimental object. Measurement of arterial blood gas analysis, plasma brain natriuretic peptide, D-dimer, troponin I and right ventricular function indicators was used to quantitative analysis. The patients were divided into three groups based on hemodynamic analysis and the results of CTPA: Non-pulmonary embolism group, non-massive pulmonary embolism group and massive pulmonary embolism group. First, we analyzed and compared arterial blood gas analysis,the level of plasma BNP, cTn I and D-dimer, the right ventricular function in three groups. Second, The correlation among CTI with arterial blood gas analysis,the level of plasma BNP, cTn I and D-dimer, the right ventricular function was assessed by Spearman rank correlation analysis. At last, the arterial blood gas analysis,the level of plasma BNP, cTn I and D-dimer, the right ventricular function were respectively evaluated with different CTI cut off values(20%,30%,40%,50%,60%). Results:1. Divided the70cases patients which was suspected to have acute pulmonary embolism into three groups based on Hemodynamic and results of CTPA: Non-pulmonary embolism group(20cases), non-massive pulmonary embolism group(27cases) and massive pulmonary embolism group(23cases). The average of the three groups of BNP were(33.53±6.45) pg/ml,(170.03±103.76) pg/ml,(556.48±75.39) pg/ml, there was significant difference (P<0.05) among the three groups; The average of the three groups of D-dimer were (523.31±23.68) u g/L,(551.38±41.08) u g/L,(896.64±275.22) u g/L, there was significant difference (P<0.05) among the three group; The average of the three groups of cTn I were (0.14±0.08) ng/ml,(2.60±2.99) ng/ml,(14.44±2.50) ng/ml, there was significant difference (P<0.05) among the three groups; The average of the three groups of PaO2were (60.50±2.86) mmHg,(57.59±4.33) mmHg,(46.35±5.87)mmHg, there was significant difference (P<0.05) among the three group; The average of the three groups of PaCO2were (35.15±2.72) mmHg,(35.33±3.14) mmHg,(33.83±4.12) mmHg, there was non-significant difference (P>0.05) among the three group; The average of the three groups of P(A-a)O2were (16.95±3.39) mmHg,(32.89±7.87) mmHg,(53.30±3.82) mmHg, there was significant difference (P<0.05) among the three group; The average of the three groups of RVd by CT were (35.92±3.84) mm,(37.89±5.16) mm,(43.60±5.89)mm, there was significant difference (P<0.05) among the three groups; The average of the three groups of R/L ratio by CT were (0.73±0.06),(0.81±0.09),(1.16±0.27), there was significant difference (P<0.05) among the three groups; The average of the three groups of RVd by Echocardiography were (37.31±4.72) mm,(38.48±4.20) mm,(41.41±3.72) mm, there was significant difference (P<0.05) among the three groups.The average of the three groups of R/L ratio by Echocardiography were (0.74±0.09),(0.82±0.08),(1.12±0.23), there was significant difference (P<0.05) among the three groups.2. There is a positive correlation between the CT pulmonary obstruction index(CTI) of50cases patients with pulmonary embolism and BNP,cTnI,D-dimer,P(A-a)02the RVD,R/L ratio by CT and the RVD,R/L ratio by Echocardiography; There is a negative correlation between the CT pulmonary obstruction index(CTI) of50cases patients with pulmonary embolism and PaO2; There is non-correlation between the CT pulmonary obstruction index(CTI) of50cases patients with pulmonary embolism and PaCO23. There was significant difference(P<0.05)between BNP,cTnI in different CTI(20%,30%,40%,50%,60%) threshold; There was significant difference(P<0.05)between D-dimer in different CTI(30%,40%,50%,60%) threshold; There was significant difference(P<0.05)between PaO2in different CTI(30%,40%,50%,60%) threshold; There was non-difference(P>0.05)between PaCO2in different CTI(20%,30%,40%,50%,60%) threshold; There was significant difference(P<0.05)between RVD by CT in different CTI(40%,50%,60%) threshold; There was significant difference(P<0.05) between R/L radio by CT in different CTI(20%,30%,40%,50%,60%) threshold; There was significant difference(P<0.05)between RVD by Echocardiography in different CTI(40%,50%,) threshold; There was significant difference(P<0.05)between R/L radio by Echocardiography in different CTI(20%,30%40%,50%,60%) threshold.Conclusion:1. In patient with PE, the correlations were existed between blood gas value, Brain natriuretic peptide(BNP), troponin I (cTnI), D-dimer, the right ventricular functions and pulmonary artery CT obstruction index. These indicators can be used to assess the clinical severity of PE;2. There were significant differencebetween BNP, cTnI, DD, arterial blood gas index and the right heart function indexes in CTI(30-40%) threshold. |
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