先天性心脏病伴肺动脉高压患者双源CT肺血管影面积百分比与肺小动脉形态变化的关系

Relationship between percentage of pulmonary vascular area by dual-source computed tomography and pulmonary vascular micromorphological indexes in patients with congenital heart disease complicated by pulmonary hypertension

目的：探讨先天性心脏病伴肺动脉高压（PH）患者双源CT肺血管影面积百分比[EA（％）=右肺层面中血管影面积和／层面中右肺总面积]与肺小动脉形态变化的关系。方法：随机选取2009年1月～12月收治92例左向右分流先天性心脏病患者，按肺动脉压力情况分为3组，先心病不并发PH组（对照组）29例，肺动脉平均压（MPAP）〈20mmHg；先心病并发PH组（PH组）55例，80mmHg〉MPAP〉20mmHg；先心病并发紫绀组8例（紫绀组），MPAP〉90mmHg。术前行肺血管双源CT，测定EA（％）值。取肺组织进行活检，观察肺血管病理变化及肺小动脉形态学变化指标。结果：肺活检切片按Heath和Edwards标准进行病理分级，无肺高压对照组29例，Ⅰ级11例，Ⅱ级16例，Ⅲ级19例，Ⅳ级9例；紫绀组（≥V级）8例。对照组EA（％）为9．37±0．13，；肺小动脉血管壁厚度占血管外径的百分比wr（％）为15．27±1．98，血管壁面积占血管总面积百分比WA（％）为21．13±4．30。参照对照组各项检查指标，随病理分级的增加，双源CT肺血管影EA（％）呈下降趋势，显影的肺血管面积占肺总面积比例减少；WT（％）及WA（％）均随病理分级增加呈上升趋势，各组之间有显著性差异（P〈0．01），一定程度上反映了病理变化程度越重，肺血管壁增生、管腔萎缩越重。结论：肺高压患者双源CT肺血管影EA（％）的变化在一定程度上能够反映肺动脉高压患者肺血管病理的变化。

AIM： To explore the relationship between the percentage pulmonary vascular area [ （EA（ % ） ] by dual-source computed tomography （CT） and the pulmonary vascular micromorphological indexes in patients with congenital heart disease complicated by pulmonary hypertension （PH）. METHODS： Ninety-two patients with congenital heart disease were randomly selected and divided into three groups according to the extent of PH ： No-PH group （29 patients） with preoperative mean pulmonary artery pressure （MPAP） 〈20 mmHg, PH group （55 patients） with preoperative MPAP 〉20 mmHg and 〈80 mmHg, and cyanosis group （eight patients） with preoperative MPAP 〉 90 mmHg. All patients had dual-source CT before surgery and EA（ % ） was calculated. Pulmonary vascular micromophological indexes were measured according to Heath-Edwards pathological grading. RESULTS： Eleven patients were grade I, 16 patients were grade II, 19 patients were grade III, 9 patients were grade IV, and 8 patients were grade V. With the increase of the PH grade, the EA （ % ） significantly decreased but the WT （ % ） and the WA （ % ） increased （ P 〈 0. 01 ）..CONCLUSION： The EA（% ） and the pulmonary vascular pathological changes are related in patients with congenital heart disease complicated by PH and the EA （%） is helpful in evaluating the extent of PH.