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目的 探讨９９ｍＴｃＭＡＡ与肺功能测定在肝肺综合征（ＨＰＳ）早期诊断中的意义。方法 选择ＨＰＳ患者（２８例）和无ＨＰＳ肝硬化患者（３０例）测定其肺功能和９９ｍＴｃＭＡＡ，同时以健康人（２１例）作为对照。结果ＨＰＳ组动脉血氧分压（ＰａＯ２）、动脉血氧饱和度（ＳａＯ２）和肺一氧化碳弥散量（ＤＬｃｏ）（分别为６．３、７６．３、６２．０ｋＰａ）显著低于肝硬化组（分别为１１．７、９０．６、８１．６ｋＰａ）（Ｐ＜０．０１）和对照组（Ｐ＜０．０１），Ｐ（Ａ－ａ）Ｏ２显著增高（Ｐ＜０．００１）；９９ｍＴｃＭＡＡ显示，ＨＰＳ患者均有肺外脏器（脾、肾、肝和脑）显影，肺内动－静脉分流比和吸入纯氧气时Ｑｓ／ＱＴ均显著高于肝硬化组（Ｐ＜０．０１）和对照组（Ｐ＜０．００１）。肝硬化组与对照组比较，ＤＬｃｏ显著减低（Ｐ＜０．０５）；Ｐ（Ａ－ａ）Ｏ２、肺内动－静脉分流比和吸入１００％氧气时Ｑｓ／ＱＴ显著增高（Ｐ＜０．００１和Ｐ＜０．００１），其中有３例（１０％）有肺外脏器显影。结论 肺功能测定和９９ｍＴｃＭＡＡ是ＨＰＳ早期诊断的较敏感的指标。
Objective To investigate the significance of 99mTcMAA and pulmonary function in the early diagnosis of hepatopulmonary syndrome (HPS). Methods Pulmonary function and 99mTcMAA were measured in HPS patients (n = 28) and non-HPS patients (n = 30). Healthy controls (n = 21) were also included. Results The arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2) and diffusing capacity of lung carbon monoxide (DLco) in HPS group were significantly lower than those in cirrhosis group (6.3,76.3,62.0 kPa respectively) (P <0.01), P (A-a) O2 significantly increased (P <0.001); 99mTcMAA The Qs / QT were significantly higher in patients with HPS than those in patients with liver cirrhosis (spleen, kidney, liver and brain), pulmonary arterio-venous shunt and inhaled pure oxygen (P <0.01) And control group (P <0.001). DLco was significantly lower in cirrhotic group than in control group (P <0.05). The Qs / QT of P (A-a) O2, intrapulmonary arterio-venous shunt and Qs / QT were significantly increased when inhaled 100% oxygen. 001 and P <0.001), of which 3 (10%) developed extrapulmonary organs. Conclusions Pulmonary function tests and 99mTcMAA are more sensitive indicators of early diagnosis of HPS.