Rubin M P
Ter Arkh. 2008;80(1):10-6.
To define informative value of a novel technique in radionuclide examination of microcirculatory and alveolar ventilation disorders in pulmonary diseases and to test its application possibilities in outpatient practice.
Perfusion static scintigraphy of the lungs with 99m-Tc-macrotech and ventilatory aerosol dynamic and static pulmonary scintigraphy after 99m-Tc-pentatech (DTPA analogue) inhalation were performed in 128 patients with bronchial asthma (BA), chronic obstructive bronchitis (COB) and pulmonary abscess.
Regional perfusion and ventilation were abnormal in all the examinees with BA and COB including in lower zones of both the lungs characteristic of pulmonary emphysema. In COB ventilation-perfusion correlations were disturbed in both lungs in 87.5%, in one lung in 100% patients. In BA patients after the attack the results of ventilatory pulmonary scintigraphy should be evaluated visually (qualitatively). In pulmonary abscess regional disorders of perfusion and/or ventilation were seen in 94.6%, lack of balance V/Q in the focal zone--in 75%, in the whole affected lung--in 55.4% patients. Compensatory synchrony of ventilation-perfusion relations in impaired regional indices V/Q took place in COB patients in 37.5%, in abscess (in the affected lung)--in 42.9%. Acceleration and delay of alveolar-capillary diffusion were detected in bronchial asthma in 76.5%, COB--in 68.7%, in abscess in the affected lung--in 48.8%, in the contralateral lung--in 56.5%.
Lung lesion can be assessed with ventilation-perfusion correlations and clearance of 99mTc-pentatech from the right and left lung.
确定一种新技术在肺部疾病微循环和肺泡通气障碍放射性核素检查中的信息价值,并测试其在门诊实践中的应用可能性。
对128例支气管哮喘(BA)、慢性阻塞性支气管炎(COB)和肺脓肿患者进行了用99m锝-大聚合白蛋白进行肺部灌注静态闪烁显像,以及吸入99m锝-喷替酸(二乙三胺五乙酸类似物)后进行通气气溶胶动态和静态肺部闪烁显像。
所有BA和COB患者的局部灌注和通气均异常,包括两肺下部出现肺气肿特征性表现。在COB患者中,两肺通气-灌注相关性均受到干扰的占87.5%,一侧肺受到干扰的占100%。BA患者发作后,通气肺部闪烁显像结果应进行视觉(定性)评估。在肺脓肿患者中,94.6%出现局部灌注和/或通气障碍,病灶区V/Q失衡的占75%,整个患肺V/Q失衡的占55.4%。在COB患者中,37.5%的患者局部V/Q指标受损区域出现通气-灌注关系的代偿性同步,在脓肿患者(患肺)中这一比例为42.9%。在支气管哮喘患者中,76.5%检测到肺泡-毛细血管扩散加速和延迟,COB患者中这一比例为68.7%,肺脓肿患侧肺为48.8%,对侧肺为56.5%。
可通过通气-灌注相关性以及99m锝-喷替酸在左右肺的清除情况来评估肺部病变。