肺通气/灌注SPECT显像动态评价肺血栓栓塞症抗凝疗效及其影响因素分析

Value of ventilation/perfusion SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism and the influencing factors of treatment effect

目的探讨肺通气/灌注(V/Q)SPECT显像对肺血栓栓塞症(PE)患者抗凝疗效评价的价值,并分析可能影响疗效的因素。方法回顾性纳入2014年7月至2016年12月间临床确诊PE、且经抗凝治疗后再次复查V/QSPECT的63例患者[男23例,女40例;年龄(60±14)岁]为研究对象。根据肺灌注缺损范围占全肺容积的百分比(%)将患者分为3组:<20%为轻度PE组,20%~50%为中度PE组,>50%为重度PE组。按治疗前后V/QSPECT图像的变化情况评估疗效:肺灌注显像正常或缺损范围较前减少≥50%且没有新发病灶为疗效好;反之为疗效差。比较组间差异,分析可能预测肺灌注缺损程度和影响疗效的因素。采用χ2检验和logistic回归分析数据。结果共有476个肺段和亚肺段受累,不同肺叶间发生PE的概率差异无统计学意义(χ^2=4.995,P>0.05)。发生肺动脉高压(PAH)的概率在灌注缺损中度PE组(66.7%,16/24)、重度PE组(12/15)明显高于轻度PE组(41.7%,10/24;χ^2=7.062,P<0.05)。PAH是预测肺灌注缺损程度的独立危险因素[比值比(OR):2.680(95%CI:1.115~6.446),P<0.05]。PE合并PAH是影响抗凝疗效的独立危险因素[OR:3.134(95%CI:1.341~7.324),P<0.05]。结论V/QSPECT显像对于指导PE抗凝治疗和评价其疗效具有重要价值。中、重度PE患者发生PAH的概率高。PE合并中、重度PAH的患者抗凝治疗的效果差。

Objective To investigate the value of pulmonary ventilation/perfusion (V/Q) SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism (PE) and identify factors which may affect the therapy. Methods From July 2014 to December 2016, sixty-three patients (23 males, 40 females, age (60±14) years), who were clinically diagnosed as PE and underwent V/Q SPECT before and after anticoagulant therapy, were recruited retrospectively in this study. According to the percentage of lung perfusion defect (PD) out of total lung volume, the patients were divided into mild (<20%) PE, moderate (20%-50%) PE, and severe (>50%) PE groups. The lung PD decreased≥50% after anticoagulant therapy and no new PD detected was defined as the standard of effective therapy, otherwise the treatment were defined as ineffective. Data of different groups were compared. Factors that may predict the severity of PD or affect the treatment were analyzed. χ^2 test and logistic regression were used for data analysis. Results PE were detected in 476 pulmonary segments and sub segments. The distribution of PE in different lung lobes had no statistically significant difference (χ^2=4.995, P>0.05). More pulmonary arterial hypertension (PAH) were detected in patients with severe PE (80%, 12/15) and moderate PE (66.7%, 16/24) in comparison with patients with mild PE (41.7%, 10/24; χ^2=7.062, P<0.05). The occurrence of PAH was related to the severity of PD, with odds ratio (OR) value of 2.680 (95% CI: 1.115-6.446, P<0.05). PAH was an independent risk factor for treatment effect (OR value: 3.134(95% CI: 1.341-7.324), P<0.05). Conclusions V/Q SPECT has an important value for evaluating the effect of anticoagulant therapy and guiding individual therapy. The more extent of PE involved, the higher prevalence of PAH. Anticoagulant therapy may be ineffective in PE patients with moderate or severe PAH.