^(99m)Tc-MAA肺灌注诊断原发性肾病综合征合并深静脉栓塞

Diagnosis of ^(99m)Tc-MAA Pulmonary Perfusion in Primary Nephrotic Syndrome Complicated with Deep Veins Embolism

目的运用Tc-MAA肺灌注和双下肢深静脉显像研究原发性肾病综合征并发肺栓塞(PE)和(或)下肢深静脉血栓(DVT)形成;同时评价D-二聚体在诊断PE和DVT形成中的价值。方法40例原发性肾病综合征患者行肺灌注和双下肢深静脉显像,同时摄胸片以排除其它肺部和心血管疾病等造成的假阳性;ELISA法测定血浆中D-二聚体水平,≥0.5mg/L为阳性。结果肺灌注和双下肢深静脉显像,显示40例中有PE和(或)DVT26例,占65%,其中D-二聚体阳性20例,占76.9%。结论应用肺灌注和双下肢深静脉显像并结合胸片,可减少对PE和(或)DVT的误诊和漏诊;D-二聚体测定不能作为PE和(或)DVT的筛选指标。

Objective Using 99mTc-MAA pulmonary perfusion and imaging of deep veins of lower limbs to study pulmonary embolism (PE) and deep veins thrombosis (DVT) in primary nephrotic syndrome, and to evaluate the value of D-dimer in the diagnosis of PE and DVT. Methods Forty patients with primary nephrotic syndrome were examined by pulmonary perfusion and imaging of the deep veins of lower limbs. At the same time chest films were taken to rule out false positive images from other pulmonary and cardiovascular diseases. D-dimer was determined by ELISA. Results Among the 40 patients, 26 were found to have PE and/or DVT (65%). In the cases with PE and/or DVT, D-dimer was in 76.9% positive. Conclusion Pulmonary perfusion and imaging of deep veins of the lower limbs play an important role in diagnosing PE and/or DVT. However, D-dimer test is unsuitable to be used as a screening method of PE and DVT.