Piirilä Päivi, Laiho Mia, Mustonen Pirjo, Graner Marit, Piilonen Anneli, Raade Merja, Sarna Seppo, Harjola Veli-Pekka, Sovijärvi Anssi
Department of Clinical Physiology, HUSLAB, Helsinki University Central Hospital, Finland.
Clin Physiol Funct Imaging. 2011 May;31(3):196-202. doi: 10.1111/j.1475-097X.2010.01000.x. Epub 2010 Dec 12.
Acute pulmonary embolism (PE) often decreases pulmonary diffusing capacity for carbon monoxide (DL,CO), but data on the mechanisms involved are inconsistent. We wanted to investigate whether reduction in diffusing capacity of alveolo-capillary membrane (DM) and pulmonary capillary blood volume (Vc) is associated with the extent of PE or the presence and severity of right ventricular dysfunction (RVD) induced by PE and how the possible changes are corrected after 7-month follow-up. Forty-seven patients with acute non-massive PE in spiral computed tomography (CT) were included. The extent of PE was assessed by scoring mass of embolism. DL,CO, Vc, DM and alveolar volume (VA) were measured by using a single breath method with carbon monoxide and oxygen both at the acute phase and 7 months later. RVD was evaluated with transthoracic echocardiography and electrocardiogram. Fifteen healthy subjects were included as controls. DL,CO, DL, CO/VA, DM, vital capacity (VC) and VA were significantly lower in the patients with acute PE than in healthy controls (P < 0.001). DM/Vc relation was significantly lower in patients with RVD than in healthy controls (P = 0.004). DM correlated inversely with central mass of embolism (r = -0.312; P = 0.047) whereas Vc did not. DM, DL,CO, VC and VA improved significantly within 7 months. In all patients (P = 0.001, P = 0.001) and persistent RVD (P = 0.020, P = 0.012), DM and DL,CO remained significantly lower than in healthy controls in the follow-up. DM was inversely related to central mass of embolism. Reduction in DM mainly explains the sustained decrease in DL,CO in PE after 7 months despite modern treatment of PE.
急性肺栓塞（PE）常降低肺一氧化碳弥散量（DL,CO），但有关其机制的数据并不一致。我们想研究肺泡-毛细血管膜弥散量（DM）和肺毛细血管血容量（Vc）的降低是否与PE的范围或PE所致右心室功能障碍（RVD）的存在及严重程度相关，以及在7个月的随访后这些可能的变化是如何得到纠正的。纳入了47例螺旋计算机断层扫描（CT）显示为急性非大面积PE的患者。通过对栓塞灶进行评分来评估PE的范围。在急性期和7个月后，采用一氧化碳和氧气单次呼吸法测量DL,CO、Vc、DM和肺泡容积（VA）。通过经胸超声心动图和心电图评估RVD。纳入15名健康受试者作为对照。急性PE患者的DL,CO、DL, CO/VA、DM、肺活量（VC）和VA显著低于健康对照（P < 0.001）。RVD患者的DM/Vc比值显著低于健康对照（P = 0.004）。DM与栓塞中心灶呈负相关（r = -0.312；P = 0.047），而Vc则无此相关性。DM、DL,CO、VC和VA在7个月内显著改善。在所有患者中（P = 0.001，P = 0.001）以及持续性RVD患者中（P = 0.020，P = 0.012），随访时DM和DL,CO仍显著低于健康对照。DM与栓塞中心灶呈负相关。尽管对PE进行了现代治疗，但DM的降低主要解释了7个月后PE患者DL,CO的持续下降。
