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目的:探讨先天性心脏病伴肺动脉高压(PH)患者双源CT肺血管影面积百分比[EA(%)=右肺层面中血管影面积和/层面中右肺总面积]与肺小动脉形态变化的关系。方法:随机选取2009年1月~12月收治92例左向右分流先天性心脏病患者,按肺动脉压力情况分为3组,先心病不并发PH组(对照组)29例,肺动脉平均压(MPAP)<20 mmHg;先心病并发PH组(PH组)55例,80 mmHg>MPAP>20 mmHg;先心病并发紫绀组8例(紫绀组),MPAP>90 mmHg。术前行肺血管双源CT,测定EA(%)值。取肺组织进行活检,观察肺血管病理变化及肺小动脉形态学变化指标。结果:肺活检切片按Heath和Edwards标准进行病理分级,无肺高压对照组29例,Ⅰ级11例,Ⅱ级16例,Ⅲ级19例,Ⅳ级9例;紫绀组(≥V级)8例。对照组EA(%)为9.37±0.13,;肺小动脉血管壁厚度占血管外径的百分比WT(%)为15.27±1.98,血管壁面积占血管总面积百分比WA(%)为21.13±4.30。参照对照组各项检查指标,随病理分级的增加,双源CT肺血管影EA(%)呈下降趋势,显影的肺血管面积占肺总面积比例减少;WT(%)及WA(%)均随病理分级增加呈上升趋势,各组之间有显著性差异(P<0.01),一定程度上反映了病理变化程度越重,肺血管壁增生、管腔萎缩越重。结论:肺高压患者双源CT肺血管影EA(%)的变化在一定程度上能够反映肺动脉高压患者肺血管病理的变化。
OBJECTIVE: To investigate the percentage of pulmonary angiography (%) in two-source CT patients with congenital heart disease complicated with pulmonary hypertension (PH), the area of the vessel in the right lung and the total area of the right lung in the slice, Relationship. Methods: A total of 92 patients with left-to-right shunt congenital heart disease were selected randomly from January 2009 to December 2009 and divided into 3 groups according to the pulmonary pressure. 29 patients with congenital heart disease without PH group (control group), mean pulmonary artery pressure MPAP) <20 mmHg; 55 cases of congenital heart disease complicated with PH group (PH group), 80 mmHg> MPAP> 20 mmHg; 8 cases of cyanotic group (cyanotic group) with congenital heart disease and MPAP> 90 mmHg. Preoperative pulmonary vascular dual source CT, measured EA (%) value. Take lung tissue for biopsy, observe the pulmonary vascular pathological changes and pulmonary arteriolar morphological changes. Results: The lung biopsy specimens were graded according to Heath and Edwards criteria. There were 29 cases without pulmonary hypertension in control group, 11 cases in grade Ⅰ, 16 cases in grade Ⅱ, 19 cases in grade Ⅲ and 9 cases in grade Ⅳ and 8 cases in cyanotic group (≥V grade) 8 example. The EA (%) in the control group was 9.37 ± 0.13; the percentage of vascular wall thickness in pulmonary arterioles to vessel outside diameter WT (%) was 15.27 ± 1.98, and the percentage of vessel wall area in total vessel area WA (%) was 21.13 ± 4.30. According to the indexes of the control group, with the increase of the pathological grade, the EA (%) of the pulmonary angiography of the dual-source CT showed a decreasing trend, and the area of the developed pulmonary vascular area in the total lung area decreased. WT (%) and WA With the increase of pathological grade, there was an upward trend with significant difference between the groups (P <0.01), to a certain extent, reflect the more severe pathological changes, pulmonary vascular wall hyperplasia, luminal atrophy heavier. CONCLUSION: The change of pulmonary angiography EA (%) in patients with pulmonary hypertension can reflect the changes of pulmonary vascular pathology in patients with pulmonary hypertension.