主动脉壁内血肿CT血管成像形态学特征与C反应蛋白的相关性研究

doi:10.24920/003494

摘要/Abstract

摘要： 目的评价主动脉壁内血肿（intramural hematoma, IMH）患者CT 血管成像（CT angiography, CTA）形态学特征,分析其与血清C反应蛋白（C-reactive protein, CRP）水平的相关性。方法搜集42名CTA诊断为IMH且在CTA同日进行血清CRP检测的患者,年龄61±14岁,性30名,女性12名。回顾性分析患者的临床资料,并在图像后处理工作站对患者CTA检查的容积数据进行回顾处理和分析。根据最大横截面积及长度-面积曲线测量IMH的真腔及管腔总横截面积,计算血肿-管腔面积比（hematoma-vessel ratio,HVR）等指标,比较其在CRP异常升高组（>0.8 mg/dl）和CRP正常组之间的差异,采用Spearman 相关分析法分析CTA形态学指标与血清CRP之间的相关性,并通过受试者工作特性（receiver operating characteristic, ROC）曲线法评价CRP对IMH的诊断效能。结果在所有42名IMH患者中,CRP的平均值为（3.94±4.71）mg/dl,范围（0-16.6）mg/dl,HVR的均值为(46.7±14.2）%,范围（12.7-81.6）%。CRP升高组的HVR高于对照组[(49.7±15.0) % vs.(40.7 ± 10.5) %, P = 0.030]。HVR与CRP呈轻度相关（r =0.48, P < 0.001）。CRP水平在IMH的Stanford A型与Stanford B型间无显著差异（P = 0.207）,在伴有与不伴有内膜缺损患者间无显著统计学差异（P = 0.230）。CRP诊断HVR > 47%（均值）的ROC曲线下面积为0.700（95% CI：0.535-0.865）,CRP最佳截断点为3.55 mg/dl,相应灵敏度和特异度分别为54.5%和90.0%。结论 CRP水平与IMH横截面血肿严重程度存在轻度正相关,但与Stanford分型及内膜缺损无关。

关键词: CT血管成像, C-反应蛋白, 主动脉壁内血肿, 急性主动脉综合症, 形态学

Abstract: Objectives To investigate the morphologic characteristics of intramural hematoma (IMH) on CT angiography (CTA), and evaluate the possible correlation of serum C-reactive protein (CRP) with morphologic characteristics of IMH. Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study, including 30 males and 12 females, with the mean age of 61 ± 14 years old. The volumetric CT data were retrospectively processed and analyzed on post-processing workstation. Based on the thickness of IMH and the length-area curve, the cross-sectional area of true lumen and total vessel were measured, the hematoma-vessel ratio (HVR) was calculated. Imaging characteristics were compared between patients who had pathological elevated CRP (> 0.8 mg/dl) and those did not. Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic validity of CRP. Results Of all 42 IMH patients, the mean serum CRP was 3.94 ± 4.71 mg/dl, and the mean HVR was 46.7%± 14.2%. HVR in patients with elevated CRP was significantly higher than those with normal CRP (49.7% ± 15.0% vs. 40.7% ± 10.5 %, P = 0.030). HVR was mildly correlated with CRP in all patients (r =0.48, P < 0.001). CRP levels differed neither between patients with Stanford type A and B (P = 0.207), nor between patients with and without intimal disruption (P = 0.230). To discriminate HVR > 47% (the mean value), the area under curve (AUC) were 0.700 (95% CI: 0.535-0.865) for CRP at a cutoff point of 3.55 mg/dl, with a sensitivity of 54.5% and a specificity of 90.0%. Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH, but not with Stanford types and the presence of intimal disruption.

Key words: CT angiography, C-reactive protein, intramural hematoma, acute aortic syndrome, morphology

基金资助: 解放军总医院林场科研扶持基金(2016FC-TSYS-1039)

Zhang Xinghua, Li Tao, Yang Li, Jin Xin, Wu Jian, Chang Ruiping, Zhang Jing. Correlation between C-reactive Protein and Morphology of Aortic Intramural Hematoma on CT Angiography[J].Chinese Medical Sciences Journal, 2019, 34(4): 241-247.

图/表 5

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Characteristics	Value
Age (year), mean ± SD (min - max)	61±14 (32-91)
Gender (male), n (%)	30 (71.4)
Hypertension*, n (%)	29 (70.7)
Diabetes*, n (%)	4 (9.8)
Chest and/or abdominal pain*, n (%)	39 (95.1)
Smoker*, n (%)	18 (43.9)
Time between onset and CTA
≤ 24 h, n (%)	34 (81.0)
> 24 h or unknown*, n (%)	8 (19.0)
Stanford type
type A, n (%)	5 (11.9)
type B, n (%)	37 (88.1)
Complication
with ULP, n (%)	14 (33.3)
without ULP, n (%)	28 (66.7)

Morphologic characteristics of IMH	All patients (n=42)		Patients with CTA≤24 h (n=34)
Morphologic characteristics of IMH	r	P	r	P
Length	0.09	0.56	0.08	0.66
True lumen area	-0.20	0.20	-0.20	0.26
Hematoma area	0.35	0.03*	0.36	0.04*
Total vessel area	0.19	0.22	0.27	0.12
Reference area^§	-0.08	0.62	-0.01	0.95
Stenosis rate^#	0.04	0.79	0.15	0.40
Hematoma-vessel ratio^‡	0.48	<0.001*	0.47	0.005*
Volume index^†	0.31	0.04*	0.30	0.09

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