摘要
目的探索99Tcm-大颗粒聚合人血清白蛋白(MAA)肺灌注断层显像评价肺动脉球囊扩张成形术(BPA)对慢性血栓栓塞性肺动脉高压(CTEPH)疗效的价值。方法回顾性纳入2017年1月至2020年4月间于首都医科大学附属北京朝阳医院接受BPA治疗的25例CTEPH患者[男4例、女21例,年龄(56.5±12.3)岁],分析BPA干预对肺叶/肺段灌注改善的疗效,分别计算BPA干预肺叶/肺段灌注改善与未改善的比例。对BPA术前、4~6次BPA后的肺灌注断层显像的全肺灌注缺损百分比(PPDs%)进行对比分析(配对t检验)。分别分析BPA术前及术后PPDs%与平均肺动脉压(mPAP)间的相关性,以及BPA后PPDs%下降百分比与mPAP下降百分比间的相关性(Pearson相关分析)。结果对于25例患者的150个肺叶,BPA术前有96.00%(144/150)的肺叶存在灌注异常并行BPA干预,术后完全改善、部分改善和未改善的肺叶分别占11.11%(16/144)、57.64%(83/144)和31.25%(45/144)。对于25例患者的450个肺段,BPA术前有62.44%(281/450)的肺段存在灌注异常并行BPA干预,术后完全改善、部分改善和未改善的肺段分别占30.60%(86/281)、37.37%(105/281)和32.03%(90/281)。BPA术后PPDs%较术前明显降低[(39.08±10.88)%与(57.88±10.46)%;t=10.40,P<0.001];BPA术后mPAP较术前亦明显减低[(32.36±10.57)与(49.08±10.23)mmHg;1 mmHg=0.133 kPa;t=10.25,P<0.001]。BPA术前和术后PPDs%与同期mPAP的相关性均无统计学意义(r值:0.01和0.27,P值:0.953和0.199),但BPA前后PPDs%下降百分比与mPAP下降百分比呈正相关(r=0.40,P=0.045)。结论BPA可显著改善CTEPH患者的肺血流灌注,降低肺动脉压;肺灌注断层显像可用于评价CTEPH患者BPA的疗效。
Objective To evaluate the efficacy of balloon pulmonary angioplasty(BPA)in chronic thromboembolic pulmonary hypertension(CTEPH)using 99Tcm-macroaggregated albumin(MAA)pulmonary perfusion tomography imaging.Methods Twenty-five patients(4 males,21 females;age(56.5±12.3)years)with CTEPH who underwent BPA from January 2017 to April 2020 in Beijing Chaoyang Hospital,Capital Medical University were enrolled retrospectively.Effect of BPA on the improvement of pulmonary lobe/pulmonary segment perfusion was analyzed,and the proportions of improved and unimproved pulmonary lobe/pulmonary segment perfusion by BPA were calculated.The percentages of perfusion defect scores(PPDs%)of lung perfusion tomography imaging before BPA and after 4-6 times BPA were compared and analyzed(paired t test).The correlations between PPDs%and mean pulmonary artery pressure(mPAP)before BPA and after BPA were analyzed respectively,and the correlation between decreased percentage of PPDs%and decreased percentage of mPAP after BPA were also analyzed(Pearson correlation analysis).Results Among 150 lobes of 25 patients,96.00%(144/150)lobes showed perfusion abnormalities before BPA.After BPA,11.11%(16/144)showed complete improvement,57.64%(83/144)showed partial improvement,and 31.25%(45/144)showed no improvement.Among 450 pulmonary segments of 25 patients,62.44%(281/450)showed perfusion abnormalities before BPA.After BPA,30.60%(86/281),37.37%(105/281),32.03%(90/281)showed complete,partial and no improvement,respectively.The post-BPA PPDs%was significantly lower than that of pre-BPA((39.08±10.88)%vs(57.88±10.46)%;t=10.40,P<0.001).The post-BPA mPAP was significantly lower than that of pre-BPA((32.36±10.57)vs(49.08±10.23)mmHg;1 mmHg=0.133 kPa;t=10.25,P<0.001).There was no significant correlation between PPDs%and mPAP either before BPA(r=0.01,P=0.953)or after BPA(r=0.27,P=0.199),but there was a positive correlation between the changes of PPDs%and mPAP(r=0.40,P=0.045).Conclusions BPA can significantly improve the pulmonary perfusion and reduce mPAP in
作者
武姣彦
王剑锋
姚丹丹
汪薇
龚娟妮
杨媛华
杨敏福
Wu Jiaoyan;Wang Jianfeng;Yao Dandan;Wang Wei;Gong Juanni;Yang Yuanhua;Yang Minfu(Department of Nuclear Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Interventional Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Radiology,Beijing Huairou Hospital,Beijing 101400,China)
出处
《中华核医学与分子影像杂志》
CAS
CSCD
北大核心
2023年第1期1-5,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
北京市医院管理中心临床医学发展专项"扬帆"计划(ZYLX202105)。
