首次通过肺灌注显像对瓣膜性心脏病合并肺动脉高压的临床价值

Evaluation of pulmonary hypertension and surgical therapeutic efficacy using first-pass radionuclide pulmonary perfusion imaging in patients with pulmonary hypertension of valvular heart disease

目的 探讨首次通过肺灌注显像 (FPPPI)联合肺灌注显像 (PPI)对瓣膜性心脏病合并肺动脉高压 (PH)的临床价值。方法 以二尖瓣病变为主的瓣膜病患者 116例 ,术前均行右心导管、FPPPI及PPI、超声心动图检查。其中 10 5例患者术后 5～ 14d再次行FPPPI及PPI,33例患者于术后 3～ 11个月进行第 3次FPPPI及PPI复查。按右心导管测得的平均肺动脉压力 (MPAP)水平分为正常、轻度升高、中度升高、重度升高组。结果 ① 116例患者FPPPI法所测肺平衡时间 (LET)、上肺野与下肺野比值 (S L)及超声心动图所测肺动脉压力 (EPAP)与右心导管所测肺动脉收缩压 (SPAP)的r值分别为0 85 6 ,0 5 0 3及 0 5 72 (P <0 0 1)。②以MPAP为标准 ,FPPPI、PPI及FPPPI +PPI测定肺动脉压力的灵敏度分别为 94 7%、78 8%及 96 4 % ,特异性分别为 6 8 3%、5 2 8%及 72 7% ,准确性分别为 85 3%、70 7%及 89 7%。③ 10 5例患者术前与术后 5～ 14dLET分别为 (2 7 71± 10 85 )s和 (2 0 96± 6 2 5 )s(P <0 0 0 1) ;S L分别为 1 4 3± 0 4 1和 1 30± 0 35 (P <0 0 0 1)。④LET在MPAP轻度、中度、重度升高组的完全改善率分别为 4 7 6 %、34 5 %及 1 4例 ;部分改善率分别为 4 0 5 %、6 2 1%及 3 4例 (P <0 0 0 1)。S

Objective To evaluate pulmonary hypertension (PH) and surgical therapeutic efficacy using first-pass radionuclide pulmonary perfusion imaging (FPPPI) and pulmonary perfusion imaging (PPI)in patients with PH of valvular heart disease. Methods One hundred and sixteen patients with valvular disease were included in the study. Swan-Ganz catheterization, echocardiography, FPPPI and PPI were performed on all patients before surgery. The patients were divided into four groups. Results ①Correlation coefficients were 0.856, 0.503 and 0.572(P<0.01) between lung equilibrium time (LET) by FPPPI, superior lung/low lung ratio (S/L) by PPI, systolic pulmonary arterial pressure (SPAP) from echocardiography and SPAP from the catheter manometer. ②The sensitivity, specificity and accuracy of PAP using FPPPI measuring were 94.7%, 68.3% and 85.3%, respectively. The sensitivity, specificity and accuracy of PAP using PPI measuring were 78.8%, 52.8% and 70.7%, respectively. The sensitivity, specificity and accuracy of PAP using FPPPI plus PPI measuring were 96.4%, 72.7% and 89.7%, respectively. ③LET by FPPPI before surgery and 5～14 d after surgery were (27.71±10.85) and (20.96±6.25) s, respectively (P<0.001). S/L by PPI were 1.43±0.41 and 1.30±0.35, respectively (P<0.001). ④Complete improvement rates of LET in the PAP slightly risen group, moderately risen group and weightily risen group were 47.6%, 34.5% and 1/4, respectively; part improvement rates of LET for corresponding groups were 40.5%, 62.1% and 3/4, respectively (P<0.001). Complete improvement rates of S/L were 31.0%, 34.5% and 0/4, respectively; part improvement rates of S/L were 35.7%, 55.2% and 3/4, respectively (P<0.05). Complete improvement rates of LET+S/L were 57.1%, 58.6% and 1/4; part improvement rates of LET+S/L were 38.1%, 41.4% and 3/4, respectively (P<0.01). Conclusions ①FPPPI is better than PPI and echocardiography for evaluating PH in valvular heart disease. ②Combined FPPPI and PPI can improve accuracy for evaluating PH in valvular heart disease. ③Combined FPPPI and PPI is an accurate method for evaluating surgical therapeutic efficacy in valvular heart disease.