摘要
目的探讨运动一静息MPI在冠状动脉狭窄50％一75％患者中的临床应用价值。方法CAG显示冠状动脉至少有1支主要血管狭窄在50％～75％间，且所有主要血管狭窄程度不超过75％的患者，在造影前后2周内行运动一静息MPI。共纳入患者244例（男178例），平均年龄（57±10）岁。负荷试验采用症状限制性运动试验，于运动高峰静脉注射显像剂”Tc^m-MIBl925MBq，1～1．5h后行运动心肌断层显像，间隔48～72h后行静息心肌显像。在断层图像上有2个不同断面、连续2个层面在同一部位出现可逆性的稀疏或缺损诊断为心肌缺血；出现不可逆性稀疏或缺损诊断为心肌梗死；当MPI无放射性稀疏或缺损为正常。分析运动一静息MPI结果以及对临床治疗方案抉择的影响。采用X。检验行统计学分析。结果共发现狭窄在50％～75％间的冠状动脉340支。运动一静息MPI正常的患者207例（84．8％），心肌缺血33例，心肌梗死3例，梗死合并缺血1例。共发现61个缺血节段、9个梗死节段，涉及43支病变血管的供血区。共14例患者行经皮冠状动脉腔内成形术，3例行CABG，其余227例患者采用药物治疗。按照MPI结果分组：MPI阴性组207例，9例采取介入治疗，其余采取药物治疗；显像阳性组37例，29例行药物治疗，8例行经皮冠状动脉腔内成形术。2组患者在治疗方案选择上差异有统计学意义（X^2=11．9，P=0．001）。结论对冠状动脉狭窄50％～75％的患者，放射性核素MPI是判断有无心肌缺血的有效方法，可以了解缺血的范围和程度，对指导临床医师选择适当的治疗方案有重要参考价值。
Objective To evaluate the clinical application of stress/rest MPI in the patients with 50% - 75% coronary artery stenosis. Methods The criteria for patient selection were that the patients should have at least one main coronary artery with stenosis more than 50% , and the maximal stenosis should be less than 75% according to CAG. The stress/rest MPI was performed in 2 weeks before or after CAG. A total of 244 patients （178 males, 66 females） with mean age （57 _＋ 10） years were included in this study. Symptom restriction stress test was used and stress MPI was performed 1 - 1.5 h after 99Tca-MIBI （925 MBq） injection at the exercise peak. Rest MPI was performed within 48 - 72 b after stress MPI. Myocardial is- chemia was diagnosed when there was a reduced uptake or even a defect in 2 different tomographic sections or in the same part of a myocardium in the continuous 2 slices. When there was an irreversible reduced up- take or defect, myocardial infarction was given as the final diagnosis. No reduced uptake or defect in all slices was shown as normal. The impact of MPI images on the selection for optimal clinical therapy plans was also discussed. X2 test was used for statistical analysis. Results A total of 340 coronary arteries with stenosis 50% - 75% were found by CAG. According to stress/rest MPI results, 207 patients （84.8%） presented normal, 33 had myocardial ischemia, 3 had myocardial infarction, and 1 had both myocardial in- farction and ischemia. In abnormal MPI images, there were 61 ischemic segments and 9 infarct segments,which were associated with 43 stenotic arteries （23 LAD, 10 LCX, and 10 RCA）. Patients were divided in- to 2 groups according to the results of MPI： Group 1 with normal MPI （207/244, 84.8% ） and Group 2 with abnormal MPI （37/244, 15.2% ）. In Group 1, 9 patients underwent coronary artery revascularization （PTCA or CABG）, and the others had medical treatment. Eight patients had PTCA and 29 patients had medical treatment in Group 2. There was a statistica
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2011年第5期313-316,共4页
Chinese Journal of Nuclear Medicine
基金
基金项目：国家科技支撑计划（2007BAl05801）
