Grimon G, André L, Bernard O, Raffestin B, Desgrez A
Department of Nuclear Medicine, Hôpital de Bicêtre, France.
J Nucl Med. 1994 Aug;35(8):1328-32.
In order to detect and quantify intrapulmonary shunts in children with liver disease, a radionuclide method was developed and evaluated in such a population.
We studied 135 children in whom the severity of liver disease, in most cases, justified consideration of liver transplantation. Patients were separated into two groups according to their resting PaO2 values under room air: 109 children were normoxic and 26 were hypoxic. A radionuclide scan was performed immediately after intravenous injection of human albumin macroaggregates. Activity of the lungs (L) and brain (B) was counted. A shunt index (SI) was calculated as SI = 100.B/L. We compared this index with blood gases and clinical follow-up.
In the normoxic group, SI was 0.43 +/- 0.30 (mean +/- s.d.); none of the 102 children with SI < 1 developed hypoxemia during their follow-up. Two of the six children with SI > 1 developed subsequent hypoxemia. In the hypoxic group, the nine children with SI < 1 did not aggravate their hypoxemia during follow-up. The 17 hypoxic children with SI > 1 later developed severe hypoxemia.
Scintigraphy with intravenous human albumin macroaggregates is more accurate than measuring arterial blood gases to detect IPS in children with cirrhosis.
为了检测和量化患有肝脏疾病儿童的肺内分流情况，我们开发了一种放射性核素方法并在这类人群中进行了评估。
我们研究了135名患有肝脏疾病的儿童，在大多数情况下，其肝脏疾病的严重程度足以考虑进行肝移植。根据患儿在室内空气中静息状态下的动脉血氧分压（PaO₂）值将患者分为两组：109名儿童为正常氧合，26名儿童为低氧血症。在静脉注射人血白蛋白大聚合体后立即进行放射性核素扫描。对肺部（L）和脑部（B）的放射性活度进行计数。计算分流指数（SI），公式为SI = 100×B/L。我们将该指数与血气分析结果及临床随访情况进行了比较。
在正常氧合组中，SI为0.43±0.30（均值±标准差）；102名SI＜1的儿童在随访期间均未发生低氧血症。6名SI＞1的儿童中有2名随后发生了低氧血症。在低氧血症组中，9名SI＜1的儿童在随访期间低氧血症未加重。17名SI＞1的低氧血症儿童后来发展为严重低氧血症。
静脉注射人血白蛋白大聚合体闪烁扫描法在检测肝硬化儿童的肺内分流方面比测量动脉血气更为准确。
