肺动态和常规肺灌注显像评估急性肺栓塞合并肺动脉高压及危险度分层

目的 应用肺动态灌注显像（DPPI）联合常规肺灌注显像（PPI）评价急性肺栓塞（APE）合并肺动脉高压（PH）患者危险度分层及预后.方法 20名（2007年10月至2009年2月）健康志愿者,男12名,女8名,年龄21～71（48.47±13.47）岁 31例（2007年10月至2009年7月）APE患者,男21例,女10例,年龄23～82（47.68±18.06）岁.所有受试者均行DPPI和PPI,对PPI图像进行半定量分析,计算全肺灌注缺损百分数（PPDs%）,按肺灌注缺损水平分组：PPDs%=0为正常组,0＜PPDs%≤10%为非常低危组,10%＜PPDs%≤20%为低危组,20%＜PPDs%≤40%为中危组,40%＜PPDs%≤60%为高危组,PPDs%＞60%为极高危组.通过勾画DPPI图像感兴趣区计算肺平衡时间（LET）.按Aujesky法对临床的危险度进行评分.用SPSS 13.0软件对所得结果进行t检验、单因素方差分析及相关性分析.结果 （1）健康组与APE组的LET分别为（12.18±3.28）和（35.78±12.59）s,差异有统计学意义（t=6.81,P＜0.01）.（2）31例APE患者LET与PPDs%相关系数（r）为0.93,决定系数（χ2）为0.87.LET与用Aujesky法进行的危险度评分呈正相关,r=0.86.（3）31例APE患者PPDs%正常、非常低危组（5例）、低危组（12例）、中危组（9例）、高危组（4例）和极高危组（1例）LET分别为（19.59±0.04）、（25.03±0.08）、（36.07±0.10）、（57.15±0.06）及（70±0.00）s,各组间进行单因素方差分析,F=16.78,P＜0.01,差异有统计学意义.结论 （1）DPPI是评价APE合并PH的可靠、简便、无创性方法.（2）DPPI方法测定LET联合PPI方法测定的PPDs%对APE患者的危险度分层及预后判断有重要价值.

Risk stratification of patients with combined acute pulmonary embolism and pulmonary hypertension using dynamic and regular pulmonary perfusion imaging

Objective To stratify the risks of patients with acute pulmonary embolism (APE) and pulmonary hypertension (PH) by dynamic pulmonary perfusion imaging (DPPI) and pulmonary perfusion imaging (PPI). Methods From October 2007 to February 2009, 20 healthy volunteers ( 12 males, 8 females; mean age =48.47 ±13.47 years) and 31 APE patients (21 males, 10 females; mean age =47.68 ±18.06 years; from October 2007 to July 2009) were included in the study. DPPI and PPI were performed in all subjects. Percentage of perfusion defect scores ( PPDs% ) were calculated by semi-quantitative analysis of PPI. Risk levels were defined according to PPDs% calculated from PPI: normal (PPDs% =0); very low risk (0 ＜ PPDs% ≤10% ); low risk (10% ＜ PPDs% ≤20% ); moderate risk (20% ＜ PPDs% ≤40% );high risk (40% ＜ PPDs% ≤60% ) and very high risk ( PPDs% ＞ 60% ). Lung equilibrium time (LET)was calculated on region of interest (ROI) drawn over DPPI. Clinical risk was scored by Aujesky method.The t-test, ANOVA and correlation analysis were used with SPSS 13.0 software. Results ( 1 ) LET in healthy volunteers and APE patients was ( 12.18 ± 3.28) and (32.90 ± 14.29) s respectively (t = 6. 81,P ＜ 0. 01 ). (2) The correlation coefficient, coefficient of determination between LET and PPDs% in APE patients were 0.93 and 0. 87, respectively. The correlation coefficient between LET and clinical risk score was 0.86. (3)The mean LET of APE patients in very low risk (n =5), low risk (n = 12), moderate risk (n=9), high risk (n=4) and very high risk groups (n=1) were (19.59 ±0.04), (25.03 ±0.08),(36.07 ±0. 10), (57.15 ±0.06) and (70 ±0.00) s, respectively. There was significant difference among APE patients with different risk levels (F =16. 78, P ＜0.01). Conclusions ( 1 ) DPPI was a reliable, convenient and non-invasive method for the evaluation of PH in APE. (2) Combined LET of DPPI and PPDs% of PPI was valuable for risk stratification and prognosis estimation in APE patients.