经胸对比增强超声心动描记术和^(99)锝-大颗粒巨聚人血清白蛋白灌注扫描用于诊断肝肺综合征的临床研究

A clinical study of CEE and ^(99m)Tc-MAA perfusion lung scan on diagnosis of hepatopulmonary syndrome

目的:探讨有效、准确诊断肝肺综合征(HPS)的方法。方法:2008年9月至2010年1月,对我院普外科和肝移植中心的104例慢性肝病(CLD)患者进行坐位动脉血气(ABG)分析、经胸对比增强超声心动描记术(CEE)和99锝-大颗粒巨聚人血清白蛋白(99mTc-MAA)肺血流灌注扫描,从中筛选并诊断出罹患HPS的患者。结果:104例患者中共诊断出18例HPS患者。ABG分析筛查出33例肺泡气-动脉血氧分压差(A-aDO2)≥15 mmHg的患者,其中包括12例动脉血氧分压异常者(PaO2<80 mmHg),A-aDO2诊断HPS灵敏度和特异度分别为100%、82.6%,PaO2分别为66.7%、100%。CEE从33例ABG分析异常者中准确诊断出所有HPS患者,灵敏度、特异度和准确度均为100%。99mTc-MAA肺血流灌注扫描诊断出11例HPS,误诊2例,灵敏度、特异度和准确度分别为61.1%、86.7%和72.7%,阳性预测值和阴性预测值分别为84.6%和65.0%。结论:本组CLD患者中HPS的发生率为17.3%。ABG分析中PaO2有很高的特异度和阳性预测值,但灵敏度较低,A-aDO2的灵敏度和阴性预测值较高,但特异度低,两者结合可筛选出所有潜在的HPS患者。CEE可从ABG分析异常者中准确地诊断出所有HPS患者,可单独用于确诊HPS。99mTc-MAA肺血流灌注扫描有一定的误诊率和漏诊率,必须和CEE结合使用,不宜常规单独用于HPS的诊断。

Objective To investigate the effective diagnostic methods of hepatopulmonary syndrome（HPS）.Methods One hundred and four patients with chronic liver disease（CLD） admitted to Department of General Surgery and Liver Transplantation Center from Sept 2008 to Jan 2010 were enrolled.All patients received artery blood gas（ABG） analysis,contrast-enhanced transthoracic echocardiography（CEE） and 99-technetium-labeled macroaggregated albumin（^99mTc-MAA） perfusion lung scan.Patients with HPS were screened and diagnosed.Results Of the 104 patients,18 cases were diagnosed as having HPS.ABG analysis screened out 33 patients with abnormal A-aDO2（≥15 mmHg）,including 12 with abnormal PaO2（80 mmHg）.The sensitivity and specificity of A-aDO2 were 100% and 82.6%,that of PaO2 were 66.7% and 100%.All 18 HPS patients were correctly diagnosed by CEE from the 33 patients with abnormal ABG analysis,both the sensitivity and specificity of CEE were 100%.Of the 18 patients with HPS,11 cases were diagnosed by ^99mTc-MAA perfusion lung scan and 2 cases were mis-diagnosed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ^99mTc-MAA perfusion lung scan were 61.1%,86.7%,72.7%,84.6% and 65.0%,respectively.Conclusions The prevalence of HPS in CLD patients is 17.3%（18/104）.PaO2 has high specificity and low sensitivity,while A-aDO2 has low specificity and high sensitivity,combination of these two parameters could screen out all potential HPS patients.CEE could diagnose correctly all HPS patients screened out by ABG analysis and could be used for diagnosing HPS independently.^99mTc-MAA perfusion lung scan has an unacceptable false positive rate as well as false negative rate,and couldn＇t be used independently as a method for diagnosing HPS.