小儿先心病重度肺高压的核素肺灌注显像与肺活检对比研究

Correlation between radionuclide pulmonary perfusion imaging and lung biopsy in severe pulmonary hypertension caused by congenital heart defects in young children

目的 对比放射性核素肺灌注显像 (PPI)与肺活检资料 ,探讨在合并重度肺动脉高压 (PH)的左向右分流先天性心脏病病儿中的相关性。方法 43例心脏畸形矫治术前行PPI检查 5 2例次 ,肺活检 2 6例 ,肺活检标本以显微图像分析仪作定量分析。经统计学处理 ,分析各参数间的相关性。结果 右肺上、下肺野计数比 (RULR)≥ 0 .70组较 <0 70组肺小动脉平均中膜厚度百分比 ( %MT) (P <0 0 1)、肺小动脉平均中膜面积百分比 ( %MS) (P <0 0 5 )显著性增高。RULR与 %MS正相关 ,回归方程为 %MS =3 819RULR +49 82 0 (P <0 .0 5 ) ,相关系数 0 44。双肺核素总计数 (LRC)与每平方厘米肺小动脉计数 (APSC)正相关 ,回归方程APSC =0 0 0 1317LRC - 342 3148(P <0 0 1) ,相关系数 0 5 7。结论 PPI参数与肺小动脉病变程度相关 ,在左向右分流先天性心脏病合并肺动脉高压病儿的手术前评价、手术适应证选择及术后随访都有临床应用价值 ,尤为适用于幼儿病例。

Objective: To study the correlation between radionuclide pulmonary perfusion imaging (PPI) data and quantitative analyzed data of lung biopsy specimens in congenital heart defects with left to right shunt associate with severe pulmonary hypertension in young children. Methods: 52 data of PPI were collected from 43 young children with severe pulmonary hypertension caused by congenital heart defects. Lung biopsies were performed in 26 cases and the specimens were quantitative analyzed. The correlation between PPI and lung biopsy was studied. Results: The percentage of wall thickness (%MT) and percentage of wall area (%MS) were significantly increased in cases with right upper to lower count ratio (RULR)≥0.70 (P<0.01 and P<0.05, respectively). RULR correlated with %MS (%MS=3.819RULR+49.820 (P<0.05), r=0.44). Lung regional radionuclide count (LRC) was correlated with pulmonary arteriole density ( arterioles per square centimeter, APSC, APSC=0.001317LRC-342.3148 (P<0.01), r=0.57). Conclusion: PPI correlates with pathologic findings. It is clinically applicable in the preoperative evaluation, operative indication selection and postoperative follow-up in children suffering congenital heart defects associate with severe pulmonary hypertension, especially in the very young children.