Xu Jian, Wang Yuhan, Gong Ying, Wang Lu, Song Yuanlin, Wu Xu
Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
Respir Res. 2025 Apr 12;26(1):137. doi: 10.1186/s12931-025-03206-9.
Chronic thromboembolic pulmonary hypertension (CTEPH) is easily misdiagnosed. Three-dimensional (3D) electrical impedance tomography (EIT) can monitor the whole-lung perfusion at the bedside. In this study, three-dimensional electrical impedance tomography (3D-EIT) features in patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH) was investigated, and nomogram models based on clinical and 3D-EIT parameters were constructed to identify CTEPH.
Patients with pulmonary hypertension (PH) due to left heart disease and chronic hypoxia were excluded. The enrolled patients were divided into CTEPH and Non-CTEPH groups by confirmatory tests. Then, history and laboratory results were collected and 3D-EIT examination was performed. Out of 70 enrolled patients, 50 cases were used as the training set to construct the nomogram model. Obtained nomogram diagnostic model was calibrated and then evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and clinical impact curves (CIC).
Through a comprehensive univariate analysis, Wald test, Akaike information criterion (AIC), and Bayesian information criterion (BIC), the nomogram model for CTEPH diagnosis based on 50 patients was constructed using venous thromboembolism (VTE) history, D-dimer, maximum of corresponding regional ventilation/perfusion ratio (V/Qmax), range between the maximum and minimum values of regional perfusion (P-Range) and the percentage of ventilation/perfusion match area (VQMatch). The C-index of the nomogram model in the training set was 0.926 (95% CI: 0.859-0.993). In the training set and test set, the nomogram model had a larger area under the curve (AUC) than models containing only VTE history, VTE history + D-dimer and EIT parameters. Both DCA and CIC analyses indicate that this model can provide significant clinical benefits.
A nomogram model combining clinical and 3D-EIT parameters facilitated the diagnosis of CTEPH.
Not applicable.
慢性血栓栓塞性肺动脉高压（CTEPH）易被误诊。三维（3D）电阻抗断层成像（EIT）可在床边监测全肺灌注情况。本研究对疑似慢性血栓栓塞性肺动脉高压（CTEPH）患者的三维电阻抗断层成像（3D-EIT）特征进行了研究，并构建了基于临床和3D-EIT参数的列线图模型以识别CTEPH。
排除因左心疾病和慢性缺氧导致的肺动脉高压（PH）患者。通过确诊试验将纳入患者分为CTEPH组和非CTEPH组。然后，收集病史和实验室检查结果并进行3D-EIT检查。在70例纳入患者中，50例用作训练集以构建列线图模型。对获得的列线图诊断模型进行校准，然后使用受试者操作特征（ROC）曲线、决策曲线分析（DCA）和临床影响曲线（CIC）进行评估。
通过全面的单因素分析、Wald检验、赤池信息准则（AIC）和贝叶斯信息准则（BIC），利用静脉血栓栓塞（VTE）病史、D-二聚体、相应区域通气/灌注比最大值（V/Qmax）、区域灌注最大值与最小值之间的范围（P-Range）以及通气/灌注匹配面积百分比（VQMatch），构建了基于50例患者的CTEPH诊断列线图模型。训练集中列线图模型的C指数为0.926（95%CI：0.859-0.993）。在训练集和测试集中，列线图模型的曲线下面积（AUC）大于仅包含VTE病史、VTE病史+D-二聚体和EIT参数的模型。DCA和CIC分析均表明该模型可提供显著的临床益处。
结合临床和3D-EIT参数的列线图模型有助于CTEPH的诊断。
不适用。
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