肝肺综合征的CT表现及临床意义

2　Jaw TS ,K uo Y T ,Liu G C ,et al .MR cholangiography in the evaluation of

neonatal cholestasis.Radiology ,1999,212(7):249

3　N orton KI ,G lass RB ,K ogan D ,et al .MR cholangiography in the evaluation

of neonatal cholestasis :initial results.Radiology ,2002,222(3):6874　G uibaud L ,Lachaud A ,T ouraine R ,et al .MR cholangiography in neonate 2sand in fants :feasibility and prelim inary applications.A JR ,1998,170(1):27

5　K im M J ,Park Y N ,Han S J ,et al .Biliary atresia in neonates and in fants :tri 2angular area of high signal intensity in the porta hepatis at T 22weighted MR cholangiography with US and histopathologic correlation.Radiology ,2000,215(5):395

(2004202209收稿　2004204219修回)

肝肺综合征的CT 表现及临床意义

薛雁山1　王峻1　陈麦林1　蔡强2　孙莉1

【摘要】　目的:探讨肝肺综合征(hepatopulm onary syndrome ,HPS )的CT 表现及临床意义。材料和方法:对39例经临床、实验室和影像学检查证实为失代偿期肝硬化(decom pensation cirrhosis ,DCC )并发HPS ,40例正常对照组的CT 扫描结果以及2例DCC 并发HPS 的肺动脉DS A 结果进行分析。观察:右肺底最大肺纹理的直径;右肺底平均密度;右下肺末梢肺纹理延伸至胸膜面的发生率。结果:右肺底最大肺纹理的直径,病例组(0.44±0.09mm )高于对照组(0.31±0.08mm ,P <0.01);病例组右肺底平均密度(-671.4±92.4Hu )大于对照组(-710.1±54.7Hu ,P <0.05);右下肺末梢肺纹理延伸至胸膜面的发生率病例组(89.7%)远大于对照组(12.5%,P <0.01)。结论:DCC 之CT 表现有下肺纹理明显增粗、密度明显增高和末梢肺纹理明显延伸至胸膜面时,提示有HPS 的CT 证据。关键词　肝硬化;肝肺综合征;CT 中国图书资料分类法分类号　R816.5

CT Findings and Clinical Signi ficance in H epatopulmonary Syndrome

Xue Yanshan ,Wang Jun ,Chen Mailing ,Cai Qiang ,Sun Li (Department o f Radiology ,the Second Hospital ,Shanxi Medi 2cal Univer sity ,Taiyuan 030001)

【Abstract 】　Purpose :T o explore CT changes and clinical significance of hepatopulm onary syndrome (HPS ).Materials and Methods :We anal 2

ysed CT data of 39patients with DCC com plicated HPS proved by clinic ,laboratory and imaging examinations and 40age 2matched control subjects ,and DS A data in pulm onary arteries of 2patients with DCC com plicated HPS.We measured in right base of lung as follow :(1)diameter of the m ost great lung 2marking ,(2)mean density and (3)incidence of lung 2marking extend to pleura.R esults :In patients with HPS (0.44±0.09mm ),the pe 2ripheral pulm onary vasculature was significantly dilated com pared with that in control subjects (0.44±0.09mm ,0.31±0.08mm ;u =6.5,P <0.01).In mean density there were a significant difference (u =2.26,0.05>P >0.01)between HPS group (-671.4±92.4Hu )and control group (-710.1±54.7Hu ).In frequency of lung 2marking extend to pleura HPS group was significantly higher than that control group (89.7%,12.5%;u =6.89,P <0.01).Conclusion :In patients with DCC significantly dilated peripheral pulm onary vasculature ,increasing density of pulm onary

base and finding of lung 2marking extend to pleura are CT evidences of com plicated HPS.K ey w ords cirrhosis ;hepatopulm onary syndrome ;tom ography ,X 2ray com puted

作者单位　1.030001　太原　山西医科大学第二医院影像科　2.

030002　太原　山西省人民医院CT 室

慢性肝病进展到一定阶段,可引起明显的全身血

流动力学变化,包括肺血流分布和压力的异常,从而引发一系列临床症候群和肺功能变化,称之为肝肺综合征(hepatopulm onary syndrome ,HPS )。HPS 的主要临床特点由肝病、肺泡—动脉血氧分压差上升和肺内血管扩张三大主征构成。HPS 是终末期肝病的一种严重的肺部并发症,有关的基础和临床研究已有报道[1,2],但影像学研究,尤其是CT 表现文献尚少述及。本研究总结了一组失代偿期肝硬化(decom pensation cirrhosis ,DCC )的病例,重点探讨HPS 的CT 表现及其临床意义。

1　材料和方法

1.1　共39例经临床、实验室和影像学检查证实为DCC ,除2例为酒精性肝硬化外,余均为肝炎后肝硬

化,其中男28例,女11例,年龄32～74岁,平均55.7岁。这些病例经临床和肺功能检查确诊并发HPS 。31例CT 平扫后增强扫描,其中2例CT 检查后1周内行