应用核素肺通气/灌注显像评估慢性血栓栓塞性肺动脉高压抗凝治疗疗效

摘要

Objective To evaluate the effect of anticoagulant therapy by pulmonary ventilation/perfusion (V/Q) imaging in chronic thromboembolic pulmonary hypertension (CTEPH) patients.Methods Thirtysix CTEPH patients (16 males,20 females,average age:(53.8±13.8) years) diagnosed by pulmonary angiography from January 2013 to December 2015 were included in this retrospective study.All patients received anticoagulant therapy for more than 6 months.They underwent pulmonary V/Q imaging before and 6 months after anticoagulant therapy.The numbers of pulmonary segments with perfusion defect,percentage of perfusion defect score (PPDs) and pulmonary arterial systolic pressure (PASP) before and after anticoagulant therapy were measured by echocardiography.Pair t test was used for data analysis.Results Before anticoagulant therapy,there were 319 pulmonary segments with perfusion defect in 36 CTEPH patients,8.9± 3.4 on average,and reduced to 8.4+3.6 after anticoagulant therapy (t =3.101,P＜0.01).The PPDs before and after anticoagulant therapy were (43.3±19.7)％ and (40.8±+20.5)％ (t=2.364,P＜0.05).In the subgroup of 9 patients with improved pulmonary perfusion,the PASP significantly decreased from (68.7±27.3)to (56.1 +±34.8) mmHg (1 mm Hg =0.133 kPa;t =2.465,P＜ 0.05) after anticoagulant therapy.In contrast,in the subgroup of 27 patients with no improved pulmonary perfusion,the PASP before and after anticoagulant therapy were (71.3±26.9) and (76.7±35.0) mmHg respectively (t=-1.511,P＞0.05).Conclusion Pulmonary V/Q imaging is a reliable method for evaluating the changes of pulmonary perfusion before and after anticoagulant therapy,and it is valuable for assessing the effect of anticoagulant therapy in CTEPH patients.%目的 应用肺通气/灌注(V/Q)显像评价慢性血栓栓塞性肺动脉高压(CTEPH)抗凝治疗的疗效.方法 回顾性分析2013年1月至2015年12月间36例经肺动脉造影确诊的CTEPH患者,其中男16例、女20例,年龄(53.8±13.8)岁.所有患者均接受6个月以上的抗凝药物治疗,并分别于抗凝治疗前和治疗后6个月接受肺V/Q显像,比较治疗前后血栓栓塞病变的肺段数、全肺灌注缺损百分数(PPDs)及肺动脉收缩压(PASP).采用配对t检验分析数据.结果 全部36例患者治疗前共319个病变肺段,抗凝治疗前的平均病变肺段数为(8.9±3.4)个,治疗6个月后减为(8.4±3.6)个(t=3.101,P＜0.01).治疗前后的PPDs分别为(43.3±19.7)％和(40.8±20.5)％,治疗后较治疗前减低(t=2.364,P＜0.05).对于灌注改善组患者(n=9),抗凝治疗后PASP也有明显的改善,分别为(68.7±27.3)和(56.1±34.8) mmHg(1 mm Hg=0.133 kPa;t=2.465,P＜0.05);而对于灌注无改善组患者(n=27),抗凝治疗后PASP无明显的变化,分别为(71.3±26.9)和(76.7±35.0) mmHg(t=-1.511,P＞0.05).结论 肺V/Q显像可用于观察CTEPH患者抗凝治疗后肺血流灌注的变化,对于评估抗凝治疗疗效具有临床应用价值.