左向右分流型先天性心脏病患儿肺部病变的特点分析

The characteristics analysis of pulmonary lesion in congenital heart disease children with left to right shunts

目的 探讨左向右分流型先天性心脏病患儿继发肺部病变的特点,为临床诊断治疗提供依据。方法 回顾分析我科室2013年~2015年确诊为左向右分流型先天性心脏病患儿的243例CT图像,由两位有资历的放射科医师按照肺部基本病变标准进行归纳总结,统计各类左向右分流型先天性心脏病患儿中,继发肺部病变的比例,并比较各类先天性心脏病患儿之间继发肺部病变特点的差异性。结果 243例左向右分流型先天性心脏病患儿中,198例继发肺部病变,占81.4%,肺内病变部位多位于双肺下叶,以左肺下叶最为多见,占61.2%,支气管异常多出现在左肺上叶支气管,占52.3%。磨玻璃样变、肺实变、肺不张、段以上支气管发育异常/狭窄及肺气肿出现的比例分别为74.7%、46.9%、17.2%、3.5%、20.2%,未见坏死病变出现。肺部病变的发生率在年龄组间有统计学意义（P〈0.05）。各年龄组中磨玻璃样变、肺实变、肺不张、段以上支气管发育异常/狭窄及肺气肿分别出现的比例为：91.2%、56.8%、16.7%、3.3%、20%;90.8%、57.4%、14.7%、2.9%、23.5%;86.2%、50.2%、24.4%、4.9%、19.5%;80.4%、46.8%、16.7%、4.2%、16.7%;80%、40%、10%、0%、20%。肺部病变的发生率在先天性心脏病分类组间无统计学意义（P〉0.05）。结论 磨玻璃样变、肺实变、肺不张、段以上支气管发育异常/狭窄及肺气肿均可在左向右分流型先天性心脏病患儿合并肺部改变中出现,且以炎症改变为主,继发肺部病变的比例总体上表现为年龄越小出现比例越高的特点,各类肺部基本病变的出现率与年龄和先天性心脏病种类无明显相关性。

Objective To investigate the characteristics of the secondary pulmonary lesions in congenital heart disease children with ＇ieft to right shunt, and to provide basis for clinical diagnosis and treatment. Methods We retrospectively analysed children in our department from 2013 to 2015, which had been diagnosed with left to right shunt congenital heart disease. The CT images pulmonary lesions characteristics of 243 cases were summarized and analyzed by two radiologists who qualified for different left to right shunt congenital heart disease children with pulmonary lesion, according to the paper lung lesions in the basic standard. And we compared the proportion of all kinds of pulmonary lesion characteristics differences between children with different congenital heart disease. Results In 245 cases of left to right shunt congenital heart disease children, 198 cases had pulmonary lesions, accounted for 81.4%. The pulmonary lesions were mostly in lobus inferior pulmonsis, especially in left lobus inferior pulmonsis, accounting for 61.2%. Bronchial anomalies appeared mostly in the left lobe bronchus lung, accounting for 52.3%. The ground glass sample change, consolidation of the lung, atelectasis, bronchial dysplasia or narrow and emphysema were 74.7% , 74.7% , 17.2% , 3.5% , 20.2% , not necrotic lesions appeared. Rate of pulmonary lesions appear between the age groups was statistically significant （ P 〈 0.05）. The ground glass sample, consolidation of the lung, atelectasis, bronchial dysplasia or narrow and emphysema in all age groups were as follows ： 91.2% , 56.8% , 16.7% , 3.3% , 16.7% ;90.8% , 57.4% , 1g.7%, 2.9%, 14. 7%; 86.2%, 50.2%, 24.4%, d.9%, 24.4%; 80.4%, 46.8%, 16.7%, 4.2%, 16.7%; 80%, 40% , 10% , 0% , 10%. Rate of pulmonary lesions appear in congenital heart disease classification between groups had no statistical significance （ P 〉 0.05）. Conclusion The ground glass sample, consolidation of the lung, atelectasis, bronchial dysplasia or narrow and emphysema all appeared in congenital heart disease children with left to right shunt of pulmonary changes, mostly with inflammatory change. The proportion of pulmonary lesions in overall performance for the characteristics of the age was smaller and higher in proportion. All kinds of basic pathological changes of lungs showed no obvious correlation with age and the kind of congenital heart disease.