摘要
目的探讨静息门控心肌灌注SPECT显像（GMPI）对男性急性ST段抬高型心肌梗死（STEMI）患者预后评估的临床价值。方法选取2014年7月至12月男性STEMI患者70例。采集患者基本资料，检测NT－proBNP、cTnI和hs－CRP，行CAG和静息GMPI检查，测定LVEDV、LVESV和LVEF，计算心肌灌注缺损区占比。随访患者发病后180 d内发生主要心脏不良事件（MACE）的情况并进行分组，采用ROC曲线分析心肌灌注缺损区占比判断预后的能力，以心肌灌注缺损区占比截断值为界值进行危险分层，将患者分为2组，绘制Kaplam－Meier生存曲线。采用两样本t检验、Mann－Whitney u检验、χ^2检验、Pearson相关和log－rank检验分析数据。结果心肌灌注缺损区占比与cTnI、hs－CRP、LVEDV和LVESV均无相关性（均P〉0.05），与NT－proBNP呈正相关（r＝0.793, P〈0.05），与LVEF呈负相关（r＝－0.609, P〈0.05）。MACE组和非MACE组间，在年龄、高血压、糖尿病、HDL－C、LDL－C、hs－CRP、cTnI、LVEDV、LVESV和LVEF上差异均无统计学意义（χ^2值：0.21和0.37，z值：－1.0和－1.2，t值：－1.6～1.5；均P〉0.05），心肌灌注缺损区占比、NT－proBNP质量浓度及病变血管支数差异均有统计学意义（t＝2.4，z值：－2.1和－3.6；均P〈0.05）。心肌灌注缺损区占比预测MACE发生的AUC为0.700，截断值为14.06%，优于NT－proBNP（z＝2.1, P〈0.05）。心肌灌注缺损区占比≥14.06%组和心肌灌注缺损区占比〈14.06%组间MACE的发生率差异有统计学意义（P〈0.01）。结论心肌灌注缺损区占比预测男性STEMI患者180 d内是否发生MACE的能力优于血清NT－proBNP，可用于对男性STEMI患者进行危险分层。
ObjectiveTo investigate the prognostic value of rest gated myocardial perfusion SPECT imaging （GMPI） in male patients with ST-segment elevation myocardial infarction （STEMI）.MethodsSeventy male patients with acute STEMI were collected from July 2014 to December 2014. General information including age, history of hypertension, diabetes and serum levels of NT-proBNP, cTnI, hs-CRP were recorded. CAG and rest GMPI were performed to measure the LVEDV, LVESV, LVEF, and the percentage of myocardial perfusion defect size （PMPDS） was calculated. All patients were followed at least 180 d and the major cardiac events （MACE） were recorded. According to the follow-up results, patients were assigned to MACE group and non-MACE group, the prognostic value of PMPDS and NT-proBNP for MACE was analyzed by ROC curve. According to the cut-off value of PMPDS, patients were divided into 2 groups, and Kaplan-Meier survival curve were drawn. The data were analyzed by two-sample t test, Mann-Whitney u test, χ^2 test, Pearson correlation analysis and log-rank test.ResultsThe PMPDS in STEMI patients was not correlated with cTnI, hs-CRP, LVEDV and LVESV （all P〉0.05）, while positively correlated with NT-proBNP（r=0.793, P〈0.05）, and negatively correlated with LVEF （r=-0.609, P〈0.05）. Between MACE group and non-MACE group, there was no statistical differences in age, history of hypertension, diabetes, serum levels of HDL-C, LDL-C, hs-CRP, cTnI, LVEDV, LVESV, and LVEF （χ^2 values： 0.21 and 0.37, z values： -1.0 and -1.2, t values： from -1.6 to 1.5; all P〉0.05）. The PMPDS, NT-proBNP, and number of stenotic vessels were significantly different between the two groups （t=2.4, z values： -2.1 and -3.6; all P〈0.05）. ROC curve analysis showed that the AUC of PMPDS was 0.700 with cut-off value of 14.06%, which was better than that of NT-proBNP （z=2.1, P〈0.05）. When patients were separated according to the cut-off value of 14.06%, there were significant differences in MACE incidence rates betwee
出处
《中华核医学与分子影像杂志》
北大核心
2017年第12期767-771,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
