Kao C H, Huang C K, Tsai S C, Wang S J, Chen G H
Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan, Republic of China.
J Nucl Med. 1996 Mar;37(3):437-41.
This study sought to evaluate lung ventilation and alveolar permeability (AP) in patients with cirrhosis of the liver.
Pulmonary function in 29 patients with cirrhosis was measured by 99mTc-DTPA aerosol inhalation lung scintigraphy, using commercial lung radio-aerosol delivery units. Equilibrium lung ventilation images were visually interpreted according to the presence or absence of inhomogeneous distribution, inverted base-to-apex gradient and segmental defects. Degree of AP damage to the upper, middle, lower and total right lung was expressed as the slopes of the time-activity curves from dynamic lung images. The patients were classified into three groups, according to cirrhotic severity, using the modified Child's classification (A = good; B = fair; C = poor). Twelve healthy nonsmokers (2 women, 10 men; 42-75 yr old) formed the control group, and all had normal chest radiographic and pulmonary function test results.
None of the 29 patients had significantly abnormal lung ventilation findings, but 13 had reduced lung ventilation in the basilar lung zone. The incidence of lung ventilation abnormalities was 20% (3 of 15), 50% (3 of 6) and 88% (7 of 8) in patients with nil, slight-to-moderate and moderate-to-severe ascites, respectively (p < 0.05 for nil versus moderate-to-severe ascites). The AP studies showed higher time-activity curve slopes for patients with cirrhosis than for normal control subjects. The slopes for the right total lung showed no significant differences among the three groups; however, those for right upper and right lower lung showed significant differences between some subgroups. In addition, albumin and bilirubin levels showed no significant correlation with slope values in cirrhotic patients.
Although lung ventilation is normal in most patients with cirrhosis of the liver (16 [55%] of 29 in the present study), the disease can predispose patients to AP damage; however, the degree of damage is not related to cirrhotic severity.
本研究旨在评估肝硬化患者的肺通气和肺泡通透性（AP）。
使用商用肺部放射性气溶胶输送装置，通过99mTc-DTPA气溶胶吸入肺闪烁显像法测量29例肝硬化患者的肺功能。根据是否存在分布不均、基底到尖部梯度倒置和节段性缺损，对平衡期肺通气图像进行视觉解读。将动态肺图像的时间-活性曲线斜率表示为右上、中、下肺及全右肺的AP损伤程度。根据改良Child分级（A = 良好；B = 中等；C = 差），将患者按肝硬化严重程度分为三组。12名健康非吸烟者（2名女性，10名男性；年龄42 - 75岁）组成对照组，所有患者胸部X线和肺功能检查结果均正常。
29例患者中无一例肺通气表现明显异常，但13例患者肺底部肺通气减少。无腹水、轻度至中度腹水和中度至重度腹水患者的肺通气异常发生率分别为20%（15例中的3例）、50%（6例中的3例）和88%（8例中的7例）（无腹水与中度至重度腹水相比，p < 0.05）。AP研究显示，肝硬化患者的时间-活性曲线斜率高于正常对照组。右全肺的斜率在三组之间无显著差异；然而，右上肺和右下肺的斜率在一些亚组之间存在显著差异。此外，肝硬化患者的白蛋白和胆红素水平与斜率值无显著相关性。
尽管大多数肝硬化患者的肺通气正常（本研究中29例中有16例[55%]），但该疾病可使患者易发生AP损伤；然而，损伤程度与肝硬化严重程度无关。
