高原肺动脉高压肺灌注显像定量分析研究

目的：探讨肺灌注显像肺血流灌注分布指数（简称P指数）定量分析法在评价高原性肺动脉高压（HAPH）中的应用价值。方法：选取31例临床确诊的HAPH患者，行肺灌注显像和右心导管检查。应用美国国立卫生研究院开发的开源软件NIH Image进行P指数定量分析，同时选取11例年龄相匹配的正常对照组进行肺灌注显像以得到灌注面积百分比标准曲线，并对全部31例患者的P指数和血流动力学参数进行相关性分析。按肺灌注显像特点将患者分为3组，比较各组间P指数的差异。结果：P指数与肺动脉收缩压（sPAP）无显著相关性，相关系数为0．102（P〉0．05）；P指数与平均肺动脉压（mPAP）及全肺阻力（TPR）呈直线相关，P指数与平均肺动脉压（mPAP）的相关系数为0．540（P〈0．01），与全肺阻力（TPR）的相关系数为0．572（P〈0．01）。图像定性分析三种特征性图像的P指数分别为9．46±1．05、13．75±4．53、18．90±5．91，呈显著性递增趋势（P〈0．05）。mPAP、1]PR亦依次呈递增趋势，但没有显著性差异。结论：肺灌注显像P指数定量分析法能够较准确反映肺动脉压力和全肺阻力等血流动力学状态，对于HAPH的诊断和疗效判断具有较好的应用前景。

Quantitative Analysis of Lung Perfusion Scan in Patients with High Altitude Pulmonary Hypertension

Objective： The aim of this study was to assess the value of lung perfusion scan in quantitative analy- sis of High Altitude Pulmonary Hypertension. Methods： Both lung perfusion scans and right heart catheterizations were performed in thirty -one patients with HAPH. Lung perfusion images were analyzed and perfusion index （P index） was obtained using quantitative software provided by NIH. Eleven age - matched control subjects underwent lung perfusion scans for drawing PAR curve. A Pearson correlation coefficient was determined between the P index and hemodynamic parameters. The patients were divided into three groups. The differences of P index among the three groups were assessed. Results：There was no correlation between P index and sPAP （r =0. 102 for sPAP, P 〉 0.05）. The P index was significantly correlated with mPAP and TPR （ r = 0.540 for mPAP, P 〈 0.01, and r = 0.572for TPR,P 〈0.01 ）. Significant differences of P index were showed in three groups divided by three typical characters in lung perfusion scan （ all P 〈 0.05 ）. The mPAP and TPR showed not significant differences for these 3 groups. Conclusions： The P index is useful indicator for quantifying the non - uniform distributions of lung perfusion scan. Quantitative assessment of lung perfusion could provide us useful information about the HAPH.