| 摘要: |
| 目的 探讨经胸超声心动图右心声学造影（cTTE）、经食管超声心动图右心声学造影（cTEE）诊断肺动静脉畸形（PAVM）的临床价值。方法 选取我院可疑PAVM阳性患者50例，均行cTTE、cTEE检查观察左心腔内微泡出现时间及微泡数量，并进行半定量分级。以经胸部CT或CT肺血管造影（CTPA）检查结果为诊断标准，绘制受试者工作特征（ROC）曲线分析并比较cTTE、cTEE对PAVM的诊断效能；采用Logistic回归分析cTTE、cTEE半定量分级与胸部CT或CTPA诊断PAVM间的关系。结果 50例可疑PAVM阳性患者经胸部CT或CTPA检查，确诊6例为PAVM阳性，44例为PAVM阴性。cTTE半定量分级结果显示，PAVM组中Ⅰ级1例、Ⅱ级1例、Ⅲ级4例。cTEE半定量分级结果显示，PAVM组中Ⅱ级1例、Ⅲ级5例。PAVM组cTTE半定量分级、cTEE半定量分级均高于非PAVM组，差异均有统计学意义（均P＜0.05）。ROC曲线分析显示，cTTE诊断PAVM的灵敏度、特异度、曲线下面积（AUC）分别为66.7%、86.4%、0.814，均低于cTEE（83.3%、88.6%、0.890），差异均有统计学意义（均P＜0.05）。Logistic回归分析显示，以半定量分级＞Ⅱ级作为诊断PAVM患病风险的截断值，cTTE高危等级（cTTE半定量分级＞Ⅱ级）患者发生PAVM的风险是低危等级（cTTE半定量分级≤Ⅱ级）患者的12.865倍；cTEE高危等级患者发生PAVM的风险是低危等级患者的39.450倍，差异均有统计学意义（均P＜0.05）。结论 对于可疑PAVM阳性的患者，cTEE检出率优于cTTE；即使cTTE、cTEE检查早期左心腔出现微泡，也应仔细考虑PAVM的存在；对于cTTE和cTEE筛查后可疑PAVM阳性患者，当cTEE半定量分级为Ⅲ级时，再完善胸部CT或CTPA检查，可减少不必要的辐射暴露。 |
| 关键词: 超声心动描记术，经胸，经食管 右心声学造影 肺动静脉畸形 |
| DOI： |
| 投稿时间：2023-06-28修订日期：2024-02-28 |
| 基金项目: |
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| The clinical value of cTTE and cTEE in diagnosing pulmonary arteriovenous malformation |
| Xue Yuan,Xu Kun,Cai Yao,Hao Meifang,Li Yiying,Zhang Jingxuan |
| () |
| Abstract: |
| Objective To explore the clinical value of transthoracic contrast echocardiography（cTTE） ，contrast transesophageal echocardiography（cTEE） in the diagnosis of pulmonary arteriovenous malformation（PAVM）.Methods 50 suspected PAVM positive patients in our hospital were selected and all underwent cTTE and cTEE examinations to observe the time and number of microvesicles in the left heart cavity, and semi quantitative grading was performed. Using chest computed tomography or computed tomography pulmonary angiography（CTPA）results as diagnostic criteria, draw receiver operating characteristic (ROC) curves to analyze and compare the diagnostic efficacy of cTTE and cTEE for PAVM; Use logistic regression to analyze the relationship between cTTE, cTEE semi quantitative grading, and chest CT or CTPA diagnosis of PAVM. Results Of the 50 suspected PAVM-positive patients who underwentchest CT/CTPA examinations simultaneously，6 were positive for PAVM and 44 were negative for PAVM.The results of cTTE semi-quantitative classification showed that there were 1 case of grade I, 1 case of grade II and 4 cases of grade III in PAVM group. The results of cTEE semi-quantitative grading showed that there were 1 case of grade Ⅱ and 5 cases of grade Ⅲ in PAVM group. The cTTE semi-quantitative grading and cTEE semi-quantitative grading in PAVM group were higher than those in non-PAVM group, and the differences were statistically significant (P < 0.05). ROC curve analysis showed that the sensitivity，specificity and area under the curve (AUC) of cTTE in diagnosing PAVM were 66.7% 、86.4% and 0.814,，respectively，which were lower than cTEE（83.3%、88.6% and 0.890），and the differences were statistically significant（P＜0.05）.Logistic regression showed that the risk of PAVM was 12.865 times higher in patients with cTTE high-risk grade (cTTE semi-quantitative grade > Ⅱ) than in patients with low risk grade (cTTE semi-quantitative grade ≤Ⅱ) with semi-quantitative grade > Ⅱ as the cut-off value for diagnosis of PAVM. The risk of PAVM in high-risk cTEE patients was 39.450 times that of low-risk CTEE patients (P < 0.05), and the difference was statistically significant. Conclusion For suspected PAVM positive patients，the detection rate of cTEE is superior to cTTE；Even if there are microbubbles in the early left ventricular cavity during cTTE and cTEE examinations，the presence of PAVM should be carefully considered；For suspected PAVM positive patients after cTTE and cTEE screening，when cTEE semi-quantitative grading is level Ⅲ，further improvement of chest CT/CTPA examination can reduce unnecessary radiation exposure. |
| Key words: Echocardiography,transthoracic,transesophageal Contrast-enhanced echocardiography Pulmonary arteriovenous malformation |
