Tetenev F F, Ageeva T S, Krivonogov N G, Dubodelova A V, Danilenko V Iu, Noll' E S, Minin S M
Ter Arkh. 2007;79(4):38-42.
To optimize the differential diagnosis of nonmassive pulmonary thromboembolism (PTE) in patients emergently admitted to a multidisciplinary hospital.
The study enrolled 36 patients with nonmassive PTE and 28 with community-acquired pneumonias (ACP). All the patients underwent a comprehensive study, including primarily a clinical study in order to search for the early clinical manifestations of PTE. Ventilation-perfusion lung scintigraphy (VPLS) was performed in 11 patients with nonmassive PTE, 28 with ACP, and 10 healthy volunteers.
The initial diagnosis of ACP was established in 26 of the 36 emergently hospitalized patients. Most early clinical manifestations of PTE and A CP were similar; their distinguishing features suggested that there might be nonmassive PTE. It is suggested that VPLS should be used for differential diagnosis in the above cases, by additionally assessing alveolar-capillary permeability. Twenty-eight patients with ACP were found to have a pronounced and significant acceleration of alveolar-capillary permeability in the affected lung at minutes 10 [23.5 +/- 1.9% (versus 8.02 +/- 3.89% in 11 patients with nonmassive PTE; p = 0.01)] and 30 of the study [33.4 +/- 1.9% (versus 13.64 +/- 4.0% in nonmassive PTE; p = 0.004)] while in nonmassive PTE, alveolar-capillary permeability corresponded to the values typical of healthy individuals, without exceeding 12 and 22% at minutes 10 and 30 of the study, respectively.
VPLS makes it possible to verify or exclude the thromboembolic nature of pulmonary perfusion disorders. If it is difficult to make a diagnosis in the presence of the clinical symptoms characteristic of both nonmassive PTE and ACE, VPLS with an additional assessment of alveolar-capillary permeability, ACP substantially increases the accuracy of differential diagnosis of nonmassive PTE and ACE.
优化多学科医院急诊收治患者中无大块肺血栓栓塞症（PTE）的鉴别诊断。
本研究纳入36例无大块PTE患者和28例社区获得性肺炎（ACP）患者。所有患者均接受了全面检查，主要包括临床检查以寻找PTE的早期临床表现。对11例无大块PTE患者、28例ACP患者和10名健康志愿者进行了通气-灌注肺闪烁扫描（VPLS）。
36例急诊住院患者中，26例初步诊断为ACP。PTE和ACP的大多数早期临床表现相似；其鉴别特征提示可能存在无大块PTE。建议在上述病例中通过额外评估肺泡-毛细血管通透性，使用VPLS进行鉴别诊断。发现28例ACP患者在研究的第10分钟[23.5±1.9%（无大块PTE的11例患者为8.02±3.89%；p = 0.01）]和第30分钟[33.4±1.9%（无大块PTE患者为13.64±4.0%；p = 0.004）]时，患侧肺的肺泡-毛细血管通透性明显且显著加快，而在无大块PTE中，肺泡-毛细血管通透性与健康个体的典型值相符，在研究的第10分钟和第30分钟分别不超过12%和22%。
VPLS能够验证或排除肺灌注障碍的血栓栓塞性质。如果在存在无大块PTE和ACP两者特征性临床症状的情况下难以做出诊断，对肺泡-毛细血管通透性进行额外评估的VPLS可大幅提高无大块PTE和ACP鉴别诊断的准确性。
