间质性肺疾病对肺动脉高压HRCT征象的影响

Effect of interstitial lung diseases on HRCT signs of Pulmonary Hypertension

目的探讨右肺上叶尖段支气管/伴行动脉直径之比值、主肺动脉直径及右下肺动脉直径对间质性肺疾病相关性肺动脉高压的诊断价值。方法超声心动图测量临床和HRCT诊断为间质性肺疾病的53例患者的肺动脉收缩压,在HRCT扫描预定层面测量右肺上叶尖段支气管与伴行动脉、主肺动脉及右下肺动脉直径,并记录间质性肺疾病病灶累及范围。分析右肺上叶尖段支气管/伴行动脉之比值、主肺动脉及右下肺动脉直径与肺动脉收缩压的相关性,以及主肺动脉直径与病灶范围之间的相关性。结果右肺上叶尖段支气管/伴行动脉直径之比值与肺动脉收缩压呈明显相关性(r=0.67,P<0.005),主肺动脉及右下肺动脉直径与肺动脉收缩压没有明显相关性(r=0.24;P=0.23和r=0.22;P=0.27)。肺动脉收缩压与间质性肺疾病范围无关(r2=0.09,P=0.49)。结论在间质性肺疾病患者中,右肺上叶尖段支气管/伴行动脉直径之比值是肺动脉高压的可靠指标,而主肺动脉扩张并非是肺动脉高压的可靠指标,主肺动脉扩张可以不表现为肺动脉高压。

Objective To evaluate the value of the ratio of apical segmental bronchus diameter in superior lobe of right lung to their accompanying pulmonary artery diameters, main pulmonary artery diameter（dPA）and dPA of lower right lung during the diagnose of the Interstitial lung diseases（ILD）.Methods Fifty-three patients with ILD clinically proved and confirmed by high resolution computed tomography（HRCT）were studied. Pulmonary artery systolic pressure（PASP）were determined by ultrasoundcardiogram,apical segmental bronchus diameter in superior lobe of right lung and their companying pulmonary artery, main PA diameter（dPA）and dPA of lower right lung were measured by using HRCT, and the extent of ILD was recorded by HRCT as well. The ratio of apical segmental bronchus diameter in superior lobe of right lung to their accompanying pulmonary artery diameters, main pulmonary artery diameter（dPA）and dPA of lower right lung were correlated with PASP. The correlations of main pulmonary artery diameter（dPA）with the extent of ILD were also analyzed. Results There were strong correlations between the ratio of apical segmental bronchus diameter in superior lobe of right lung to their accompanying pulmonary artery diameters and PASP（r=0.67,P〈0.005）,while,there were no significant correlations between main pulmonary artery diameter（dPA）and dPA of lower right lung with PASP（（r=0.24;P=0.23,r=0.22;P=0.27）.The dPA had no relations with the extent of ILD（r2=0.09,P=0.49）. Conclusion The ratio of apical segmental bronchus diameter in superior lobe of right lung to their accompanying pulmonary artery diameter is a reliable index to PH, in contrast PA dilatation is unreliable sign to PH. PA dilatation may occurs without any indicator of pulmonary hypertension（PH）in patients with ILD.