肝硬化患者肝肺综合征核素诊断方法的一项对比研究

Contrasting methods for diagnosing hepatopulmonary syndrome in liver cirrhosis

目的:评价和比较2毫居(mci)全身显像法和2 mci部显像法诊断肝肺综合征(HPS)的优劣,探讨更为实用的诊断方法.方法:选择2004年住院的55例肝硬化患者和8例健康志愿者,利用^(99m)锝(Tc)标记的多聚白蛋白(MAA)灌注显像技术,采用2 mci全身显像法和2 mci局部显像法测定其肺内分流率并诊断HPS.结果:2 mci全身显像组与2 mci局部显像组的55例肝硬化患者分流率分别为3.16%±1.58%和3.18%±1.60%,其诊断HPS的检出率分别为7.27%和9.09%,两种方法检出率相比均无统计学差异.采用2 mci全身显像方法,测定对照组分流率均数为2.76%.HPS组为6.87%,非HPS组为2.86%.采用2 mci局部显像法,测定对照组分流率均数为2.52%,HPS组为6.85%,非HPS组为2.82%.两种方法健康对照组与非HPS组分流率均无统计学差异(P=0.811和P= 0.461,HPS组分流率高于健康对照和非HPS组(P<0.001).经计算Kappa值为0.88,说明两种检验方法检验结果一致性属于最强.结论:肝肺综合征的核素诊断方法应进一步统一和规范,2 mci全身显像法和2 mci局部显像法在肝肺综合征的诊断中均可靠、安全而实用,值得在国内推广.

AIM： To evaluate and compare the methods of ^99Tc-labeled macro-aggregates of albumin （MAA） lung and brain scanning, and whole- body scanning for diagnosis of hepatopulmonary syndrome （HPS） in patients with cirrhosis. METHODS： We studied 55 consecutive inpa- tients with cirrhosis seen in 2004, along with eight healthy volunteers. 99mTc-labeled MAA lung and brain scanning or whole-body scanning was carried out to diagnose HPS. ^99mTc- MAA scanning was undertaken follow the same protocol. RESULTS： In 55 patients with hepatic cirrhosis, we carried out both 2 mci whole-body scanning and 2 mci lung and brain scanning at the same time, the shunt rate was 3.16 ± 1.58% and 3.18 ±1.60%, and the detection rate of HPS was 7.27% and 9.09%, respectively （P = 1.00）. Patients who were diagnosed according to the criteria for HPS were included in the HPS group. Other patients were included in the non-I-IPS group. For wholebody scanning, the mean shunt rate was 2.76% in the control group, 6.87% in the HPS group, and 2.86% in the non-HPS group. For lung and brain scanning, the mean shunt rate was 2.52% in the control group, 6.85% in the HPS group, and 2.82% in the non-HPS group. The shunt rate in the HPS group was higher than that in non-HPS and control groups （P 〈 0.001）. The kappa value was 0.88, which showed that there was good consistency between the two methods. CONCLUSION： Different methods for diagnosing HPS in patients with liver cirrhosis should be unified and standardized. Both 2 mci ^99mTc- MAA whole-body scanning and 2 mci 99mTC-MAA lung and brain scanning are safe, reliable and pragmatic means for diagnosing HPS.