高原肺水肿的CT表现及动态观察

The dynamic change of CT radiopathology of high altitude pulmonary edema

目的 观察高原肺水肿 (HAPE)的CT影像表现及变化特点 ,并比较CT与X线平片异常征象的显示率。方法 32例患者中男 19例 ,女 13例 ,年龄 19～ 5 4岁 ,年龄中位数 35 5岁。其中 9例早期发现者在病程中进行了连续CT扫描和胸部X线平片检查。结果 (1)CT表现 :32例HAPE中 2 8例右肺病变重于左肺 (χ2 =93 0 8,P <0 0 1) ;HAPE早期和恢复期以肺间质异常表现为主 ;进展期与稳定期以肺实质病变为主 ,在未实变区域可见明显的代偿性肺气肿 ;病程中 ,肺实质表现从磨玻璃样变逐渐过渡到结节样实变再融合为大片实变。 (2 )以肺间质异常表现为主的早期和恢复期CT检查显示的异常征象细节明显优于平片 (χ2 =11 4 6 ,P <0 0 1)。而在以肺实质受累为主的进展期与稳定期 ,尽管CT显示的异常征象细节多于平片 ,但其显示的主要征象两者差异无显著性意义(χ2 =2 12 ,P >0 0 5 )。结论 CT扫描可发现HAPE早期病例 ,准确判定病程 ,评价治疗效果 ,提高该病的防治水平。

Objective To observe the CT manifestations and their radiological features of high altitude pulmonary edema (HAPE), and to compare the detection rate of abnormal findings between CT and chest X-ray film.Methods Thirty-two subjects (male=19, female=13; age range 19～54 years, median age=35.5) were included in this study.Nine of the patients had continuous CT scans and X-ray examinations.Results (1) CT scan manifestations: 28 of the 32 patients demonstrated more significant pathological changes in their right lungs (χ2=93.08, P<0.01). In the early and recovery stages of HAPE, abnormal interstitial tissues were dominant; while in the developing and stable stages, the consolidation of the lung tissue manifested the most, and obvious compensative emphysema was observed in the non-consolidated areas. The manifestation of the consolidation in the course of HAPE developed gradually from“ ground-glass” appearance in the lobules to nodular consolidation then to large area consolidation. (2) CT scan was able to show more details of the pulmonary change than the X-ray in the early and recovery stages (χ2=11.46, P<0.01); while there was no significant difference in the developing and stable stages (χ2=2.12,P>0.05).Conclusion CT scan can detect HAPE in the early stage, and it can also accurately determine the course of the disease, assess the treatment effects, and improve the prevention and management of HAPE.