CAJ | 학술논문

目的探讨紫绀型先天性心脏病(简称紫绀型先心病)患者颅内血管密度增高的CT表现及机制.方法回顾性分析82例紫绀型先心病患者术前头颅CT平扫和临床资料,按颅内血管密度增高程度分为正常密度组、轻度增高组、中度增高组及重度增高组,将血管密度增高程度与血红蛋白(Hb)浓度、红细胞计数(RBC)、红细胞压积(HCT)值及临床紫绀程度进行对比分析.不同组间静脉窦内血液CT值及Hb、RBC、HCT值的比较采用方差分析；对血液CT值与Hb浓度的相关性进行描述性分析和直线回归分析；血管密度与紫绀程度的相关性采用Spearman等级相关分析.结果 82例中,CT表现脑血管密度正常12例(14.6％),脑血管密度增高70例(85.4％).其中,轻度增高组22例(26.8％),CT值为(55.4 ±2.6)HU,Hb浓度为(169±6)g/L,RBC为(5.8±0.3)×1012/L,HCT为0.51 ±0.03；中度增高组29例(35.4％),CT值为(61.3±2.9)HU,Hb浓度为(209±15) g/L,RBC为(7.1 ±0.4)×1012/L,HCT为0.66±0.06;重度增高组19例(23.2％),CT值为(68.8 ±4.2)HU,Hb浓度为(242±23) g/L,RBC为(8.3±0.9) ×1012/L,HCT为0.78 ±0.08.不同组间血液CT值及Hb、RBC、HCT值差异均有统计学意义(F值分别为163.263、134.703、120.974、136.541,P值均＜0.01).血液CT值与Hb浓度呈正相关(r=0.98,P＜0.01).血管密度与紫绀程度呈等级正相关(r =0.86,P＜0.01).结论紫绀型先心病患者颅内血管密度多呈不同程度增高,增高程度与Hb浓度正相关；临床上与紫绀程度正相关.
목적 탐토자감형선천성심장병(간칭자감형선심병)환자로내혈관밀도증고적CT표현급궤제.방법 회고성분석82례자감형선심병환자술전두로CT평소화림상자료,안로내혈관밀도증고정도분위정상밀도조、경도증고조、중도증고조급중도증고조,장혈관밀도증고정도여혈홍단백(Hb)농도、홍세포계수(RBC)、홍세포압적(HCT)치급림상자감정도진행대비분석.불동조간정맥두내혈액CT치급Hb、RBC、HCT치적비교채용방차분석；대혈액CT치여Hb농도적상관성진행묘술성분석화직선회귀분석；혈관밀도여자감정도적상관성채용Spearman등급상관분석.결과 82례중,CT표현뇌혈관밀도정상12례(14.6％),뇌혈관밀도증고70례(85.4％).기중,경도증고조22례(26.8％),CT치위(55.4 ±2.6)HU,Hb농도위(169±6)g/L,RBC위(5.8±0.3)×1012/L,HCT위0.51 ±0.03；중도증고조29례(35.4％),CT치위(61.3±2.9)HU,Hb농도위(209±15) g/L,RBC위(7.1 ±0.4)×1012/L,HCT위0.66±0.06;중도증고조19례(23.2％),CT치위(68.8 ±4.2)HU,Hb농도위(242±23) g/L,RBC위(8.3±0.9) ×1012/L,HCT위0.78 ±0.08.불동조간혈액CT치급Hb、RBC、HCT치차이균유통계학의의(F치분별위163.263、134.703、120.974、136.541,P치균＜0.01).혈액CT치여Hb농도정정상관(r=0.98,P＜0.01).혈관밀도여자감정도정등급정상관(r =0.86,P＜0.01).결론 자감형선심병환자로내혈관밀도다정불동정도증고,증고정도여Hb농도정상관；림상상여자감정도정상관.
Objective To investigate CT features on increased cerebral vascular density and its pathological mechanism in patients with cyanotic congenital heart disease(CCHD).Methods Preoperative brain CT scan and clinical data in 82 patients suffering from CCHD were analyzed. According to the increased levels of vascular density,patients were divided into 4 groups:normal,mild,moderate and severe.Relationships between the increased levels of vascular density and Hb,RBC,HCT,as well as the degree of cyanosis,were studied.AVONA was carried out to test blood CT value of cerebral sinuses,Hb,RBC and HCT in different groups. Descriptive analysis and linear regression were adopted to study the correlation between blood CT value and Hb concentration.The relationship of increased vascular density to degrees of cyanosis was analysed by Spearman.Results Among 82 patients,12 patients ( 14.6％ ) were found in the group of normal vascular density and 70 patients ( 85.4％ ) in the increased vascular density group.Among 70 patients with increased vascular density,22 patients (26.8％ ) with (55.4 ± 2.6) HU,(169 ±6)g/L of Hb,(5.8 ±0.3) × 1012/L of RBC and 0.51 ±0.03 of HCT,29 patients (35.4％) with (61.3 ± 2.9) HU,(209 ± 15 ) g/L,(7.1 ± 0.4) × 1012/L,0.66 ± 0.06 and 19 patients ( 23.2％ ) with ( 68.8 ± 4.2) HU,( 242 ± 23 ) g/L,( 8.3 ± 0.9 ) × 1012/L,0.78 ± 0.08 were observed in the mild,moderate and severe group,respectively.There were significant differences in distribution of blood CT value ( HU),Hb,RBC and HCT in different groups ( F =163.263,134.703,120.974,136.541 ;P ＜ 0.01 ).Blood CT value was positively correlated with Hb concentration ( r =0.98,P ＜ 0.01 ). Vascular density was also positively correlated with the degree of cyanosis ( r =0.86,P ＜ 0.01 ). Conclusions Cerebral vascular density of patients suffering from CCHD presented different levels of increases based on CT scan results due to rise of RBC stimulated by anoxia.The increased level of vascular density was positively correlated with blood Hb concentration,and also associated with RBC accunulation caused by abnormal blood circulation.Moreover,it was positively correlated with the degree of cyanosis.