动态肺灌注显像评价特发性肺动脉高压的临床研究

Dynamic pulmonary perfusion imaging in patients with idiopathic pulmonary arterial hypertension

目的探讨动态PPI用于IPAH的临床应用价值。方法2009年7月至2010年12月间20例经右心导管及肺动脉造影检查确诊为IPAH的连续病例和10名健康对照者，接受动态PPI。以双肺为ROI，得到时间一放射性曲线，计算显像剂从进入肺内到肺内放射性分布达到平衡的肺平衡时间（LET）。组间比较采用t检验，LET与右心导管测得的血流动力学参数进行Pearson相关分析。结果IPAH患者LET平均为（33．94-15．5）S，而健康对照组仅为（14．44-3．7）s，IPAH患者LET明显延长（t=5．340，P〈0．001）。LET与mPAP、全肺阻力（TPR）间具有直线相关性（分别为r=0．566，P〈0．01和r=0．688，P〈0．05），与cI呈直线负相关（r=一0．480，P〈0．05）。结论动态PPI对于无创性评估IPAH血流动力学变化程度及右心功能具有一定的应用价值。

Objective To investigate the value of dynamic PPI in patients with IPAH. Methods Twenty consecutive patients with IPAH underwent dynamic PPI and fight ventricular catheterization. Ten healthy volunteers were also recruited in this study as control. Total lung ROI was drawn to calculate time-activity curves from dynamic PPI. Lung equilibrium time （LET）, the duration from 99Tcm-MAA entering the lungs to equilibrium, was measured. Comparisons between two groups were carried out using t-test. Correlations between LET and hemodynamic parameters were determined by Pearson correlation analysis. Results LET was significantly prolonged in IPAH patients over the control group （（33.9 ＋ 15.5 ） s vs （14.4 ＋ 3.7） s, t = 5. 340, P 〈0. 001 ）. Significant correlations were found between LET and mPAP（r =0. 566, P 〈0.01 ） and between LET and total pulmonary resistance （TPR） measured by right heart catheterization （r = 0. 688, P 〈 0. 05）. LET had a negative linear relationship with CI （r = - 0. 480, P 〈 0. 05）. Conclusion Dynamic PPI is a practi- cal and noninvasive method for evaluating the haemodynamic function of right heart in patients with IPAH.