CTEPH患者抗凝治疗前后核素肺通气/灌注定量参数变化及与右心室功能的关联性

摘要/Abstract

摘要： 目的探讨慢性血栓栓塞性肺动脉高压（CTEPH）患者抗凝治疗前后核素肺通气/灌注（V/Q）定量参数变化及与右心室功能关联性。方法选取2019年5月至2021年6月湖北省黄梅县人民医院收治的93例CTEPH患者,确诊后开始抗凝治疗,共治疗6个月,于治疗前、治疗6个月后分别进行V/Q检查,根据治疗6个月后肺灌注是否有改善分为改善组、无改善组,比较两组治疗前、治疗6个月后病变肺段数、全肺灌注缺损百分比（PPDs）、右心室功能指标[肺动脉收缩压（PASP）、舒张末期右室横径（RVTD）/左室横径（LVTD）、三尖瓣环收缩期位移（TAPSE）、右室面积变化分数（FAC）],应用Pearson分析治疗前后V/Q定量参数变化与右心室功能关系。结果治疗6个月后病变肺段数、PPDs低于治疗前[（6.61±2.05 vs 8.99±2.24）个、（35.35±10.24 vs 47.01±12.59）%],差异有统计学意义（P<0.05）;且治疗6个月后未见有肺血流灌注进一步加重现象,其中59例患者肺部血流灌注改善,34例患者肺部血流灌注无明显变化;改善组治疗6个月后病变肺段数、PPDs低于无改善组[（5.33±1.27 vs 8.84±2.52）个、（29.76±8.18 vs 45.04±10.25）%],差异有统计学意义（P<0.05）;改善组治疗6个月后PASP、RVTD/LVTD低于无改善组[（55.37±14.80 vs 70.05±17.66）mmHg、（0.80±0.12 vs 1.12±0.15）],TAPSE、FAC高于无改善组[（15.60±1.87 vs 13.57±2.09）mm、（36.51±5.18 vs 32.87±5.44）%],差异有统计学意义（P<0.05）;改善组治疗前后病变肺段数变化（3.69±0.73）个、PPDs变化（17.93±3.11）%与PASP变化（14.68±2.95）mmHg、RVTD/LVTD变化（0.32±0.11）、TAPSE变化（2.03±0.47）mm、FAC变化（3.61±0.86）%呈正相关,差异有统计学意义（P<0.05）;无改善组治疗前后病变肺段数变化（0.11±0.02）个、PPDs变化（0.79±0.24）%与PASP变化（2.83±0.81）mmHg、RVTD/LVTD变化（0.01±0.01）、TAPSE变化（0.32±0.12）mm、FAC变化（0.87±0.22）%无相关性（P>0.05）。结论抗凝治疗能改善CTEPH患者肺血流灌注、右心室结构与功能,V/Q显像能准确评估抗凝治疗后肺血流灌注改变,在抗凝治疗疗效评价中有重要现实意义,且肺血流灌注增加与右心室结构和功能恢复相关。

关键词: 慢性血栓栓塞性肺动脉高压, 抗凝治疗, 核素肺通气/灌注, 右心室功能, 关联性

张燕妮, 詹鑫亮, 熊苗. CTEPH患者抗凝治疗前后核素肺通气/灌注定量参数变化及与右心室功能的关联性[J]. 心血管病防治知识, 2026, 16(3): 31-36.

参考文献

[1] Gerges M,Yacoub M.Chronic thromboembolic pulmonary hypertension - still evolving[J].Glob Cardiol Sci Pract,2020,2020(1):e202011.
[2] Chong CZ,Tay ELW,Sia CH,et al.Chronic thromboembolic pulmonary hypertension: a review[J].Singapore Med J,2021,62(7):318-325.
[3] Rashidi F,Parvizi R,Bilejani E,et al.Evaluation of the Incidence of Chronic Thromboembolic Pulmonary Hypertension 1 Year After First Episode of Acute Pulmonary Embolism: A Cohort Study[J].Lung,2020,198(1):59-64.
[4] Wang L,Wang M,Yang T,et al.A Prospective, Comparative Study of Ventilation-Perfusion Planar Imaging and Ventilation-Perfusion SPECT for Chronic Thromboembolic Pulmonary Hypertension[J].J Nucl Med,2020,61(12):1832-1838.
[5] Ambroz D,Jansa P,Kuchar J,et al.Predictors of survival in patients with pulmonary hypertension and acute right heart failure[J].Bratisl Lek Listy,2020,121(3):230-235.
[6] 中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,等.肺血栓栓塞症诊治与预防指南[J].中华医学杂志,2018,98(14):1060-1087.
[7] 杨冬竹,吴大勇,马荣政,等.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[J].中华核医学与分子影像杂志,2018,38(7):481-484.
[8] Chen ZW,Wu CK,Kuo PH,et al.Efficacy and safety of balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension[J].J Formos Med Assoc,2021,120(3):947-955.
[9] Ciurzyński M,Kurzyna M,Kopeć G,et al.Opinia Sekcji Krążenia Płucnego Polskiego Towarzystwa Kardiologicznego dotycząca badań przesiewowych w kierunku CTEPH u chorych po przebytej ostrej zatorowości płucnej[A statement the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for CTEPH patients after acute pulmonary embolism[J].Kardiol Pol,2017,75(6):620-627.
[10] Das JP,Yeh R,Schöder H.Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE[J].Eur J Nucl Med Mol Imaging,2021,48(3):794-799.
[11] Bajc M,Schümichen C,Grüning T,et al.EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond[J].Eur J Nucl Med Mol Imaging,2019,46(12):2429-2451.
[12] LaFrance N,Fournier F.Radioaerosols and the updated EANM guideline in ventilation/perfusion imaging[J].Eur J Nucl Med Mol Imaging,2020,47(7):1640-1642.
[13] Kearon C,Kahn SR.Long-term treatment of venous thromboembolism[J].Blood,2020,135(5):317-325.
[14] Braams NJ,van Leeuwen JW,Vonk Noordegraaf A,et al.Right ventricular adaptation to pressure-overload: Differences between chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension[J].J Heart Lung Transplant,2021,40(6):458-466.
[15] Tao X,Liu M,Liu W,et al.CMR-based heart deformation analysis for quantification of hemodynamics and right ventricular dysfunction in patients with CTEPH[J].Clin Respir J,2020,14(3):277-284.
[16] Sumimoto K,Tanaka H,Mukai J,et al.Effects of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension on remodeling in right-sided heart[J].Int J Cardiovasc Imaging,2020,36(6):1053-1060.
[17] Özgüven S,Kesim S,Öksüzoğlu K,et al.Correlation Between Perfusion Abnormalities Extent in Ventilation/Perfusion SPECT/CT with Hemodynamic Parameters in Patients with Chronic Thromboembolic Pulmonary Hypertension[J].Mol Imaging Radionucl Ther,2021,30(1):28-33.