Meng X P, Sun X B, Xu W Q, Tao X C, Xie W M, Liu M
Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China.
Department of Pulmonary and Critical Care Medicine, National Respiratory Disease Center,China-Japan Friendship Hospital, Beijing 100029,China.
Zhonghua Jie He He Hu Xi Za Zhi. 2023 Aug 12;46(8):774-780. doi: 10.3760/cma.j.cn112147-20230630-00352.
To compare the differences in pulmonary vascular morphological parameters between patients with chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension(CTEPH), and to explore the value of pulmonary artery morphology in the differential diagnosis of CTEPD and CTEPH. Thirty-nine patients with CTEPH [14 males, 25 females, mean age: (54.1±12.4) years] and 29 patients with CTEPD [10 males, 19 females, mean age: (51.4±18.0) years] from January 2018 to December 2020 were retrospectively included. The pulmonary artery and vein tree was segmented from the computed tomography pulmonary angiography (CTPA) images, and the morphological parameters of pulmonary vessels including the number of pulmonary arteries, pulmonary arterial tortuosity(distance metric, DM) and fractal dimension (FD), were calculated. The differences in pulmonary vascular morphological parameters between the two groups were compared, and the correlation between morphological parameters and hemodynamics was analyzed. There was no significant difference in gender and age between CTEPH and CTEPD groups (χ=0.015,=0.904 & =-0.729, =0.469). The number of pulmonary arteries in CTEPH group (=249.43±76.27) was significantly lower than that in CTEPF group (=298.79±78.11, =2.612, =0.011). The pulmonary arterial tortuosity in CTEPH group (DM=1.26±0.17) was significantly higher than that in CTEPD group (DM=1.17±0.10, =3.516, =0.002). There was no significant difference in FD between CTEPH and CTEPD (FD=3.01±0.21 & 3.08±0.22, =1.359, =0.179). The number of pulmonary arteries was negatively correlated with pulmonary vascular resistance (=-0.325, =0.026). Pulmonary arterial tortuosity was positively correlated with mean pulmonary artery pressure (=0.387,=0.017), and was positively correlated with pulmonary vascular resistance (=0.647, <0.001). Pulmonary artery curvature is an important morphological parameter in differentiating CTEPH from CTEPD, and is related to mean pulmonary artery pressure and pulmonary vascular resistance.
比较慢性血栓栓塞性肺疾病（CTEPD）和慢性血栓栓塞性肺动脉高压（CTEPH）患者肺血管形态学参数的差异，探讨肺动脉形态在CTEPD和CTEPH鉴别诊断中的价值。回顾性纳入2018年1月至2020年12月的39例CTEPH患者[男14例，女25例，平均年龄：（54.1±12.4）岁]和29例CTEPD患者[男10例，女19例，平均年龄：（51.4±18.0）岁]。从计算机断层扫描肺动脉造影（CTPA）图像中分割出肺动脉和肺静脉树，并计算肺血管的形态学参数，包括肺动脉数量、肺动脉迂曲度（距离度量，DM）和分形维数（FD）。比较两组肺血管形态学参数的差异，并分析形态学参数与血流动力学之间的相关性。CTEPH组和CTEPD组在性别和年龄上无显著差异（χ=0.015，=0.904&=-0.729，=0.469）。CTEPH组的肺动脉数量（=249.43±76.27）显著低于CTEPF组（=298.79±78.11，=2.612，=0.011）。CTEPH组的肺动脉迂曲度（DM=1.26±0.17）显著高于CTEPD组（DM=1.17±0.10，=3.516，=0.002）。CTEPH和CTEPD之间的FD无显著差异（FD=3.01±0.21&3.08±0.22，=1.359，=0.179）。肺动脉数量与肺血管阻力呈负相关（=-0.325，=0.026）。肺动脉迂曲度与平均肺动脉压呈正相关（=0.387，=0.017），与肺血管阻力呈正相关（=0.647，<0.001）。肺动脉曲率是鉴别CTEPH和CTEPD的重要形态学参数，且与平均肺动脉压和肺血管阻力有关。
