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目的 探讨肺通气/灌注(V/Q)SPECT显像对肺血栓栓塞症(PE)患者抗凝疗效评价的价值,并分析可能影响疗效的因素.方法 回顾性纳入2014年7月至2016年12月间临床确诊PE、且经抗凝治疗后再次复查V/Q SPECT的63例患者[男23例,女40例;年龄(60±14)岁]为研究对象.根据肺灌注缺损范围占全肺容积的百分比(％)将患者分为3组:50％为重度PE组.按治疗前后V/Q SPECT图像的变化情况评估疗效:肺灌注显像正常或缺损范围较前减少≥50％且没有新发病灶为疗效好;反之为疗效差.比较组间差异,分析可能预测肺灌注缺损程度和影响疗效的因素.采用 χ2检验和logistic回归分析数据.结果 共有476个肺段和亚肺段受累,不同肺叶间发生PE的概率差异无统计学意义(χ2=4.995,P>0.05).发生肺动脉高压(PAH)的概率在灌注缺损中度PE组(66.7％,16/24)、重度PE组(12/15)明显高于轻度PE组(41.7％,10/24;χ2=7.062,P 0. 05). More pulmonary arterial hypertension (PAH) were detected in patients with severe PE (80％, 12/ 15) and moderate PE (66.7％,16/ 24) in comparison with patients with mild PE (41.7％,10/ 24; χ2 = 7.062, P<0.05). The occurrence of PAH was related to the severity of PD, with odds ratio (OR) value of 2.680 (95％ CI: 1.115-6.446, P<0. 05).PAH was an independent risk factor for treatment effect (OR value: 3.134(95％ CI: 1.341-7. 324), P<0. 05). Conclusions V/ Q SPECT has an important value for evaluating the effect of anticoagulant therapy and guiding individual therapy. The more extent of PE involved, the higher prevalence of PAH. Anticoagu-lant therapy may be ineffective in PE patients with moderate or severe PAH.