摘要
目的 探讨三磷酸腺苷（ATP）负荷99m锝-甲氧基异丁基异腈(99mTc-MIBI)门控心肌单光子发射计算机断层显像（SPECT）在评价冠状动脉临界病变危险分层中的价值。方法 选择100例以冠状动脉造影明确诊断为冠状动脉临界病变的患者,行ATP负荷99mTc-MIBI门控心肌SPECT显像检查,将左心室心肌短轴和垂直长轴像划分为17个节段,采用视觉半定量评价法评价各心肌节段核素分布情况,计算左心室负荷总积分（SSS）、左心室静息总积分（SRS）、左心室总积分差（SDS）,统计缺血节段数,根据SSS值和缺血节段数对患者进行危险分层;分析冠状动脉临界病变患者的危险分层及心肌缺血程度;探究冠状动脉临界病变狭窄程度与心肌缺血及危险分层的相关性。结果 100例冠状动脉临界病变患者,其中单支病变患者62例,双支病变患者33例,三支病变患者5例。对临界病变患者进行危险分层:低危组45例（45.0%）,中危组34例（34.0%）,高危组21例（21.0%）。多支病变组高危患者比例高于单支病变组,多支病变组SSS和SDS值也高于单支病变组（P<0.05）,而SRS值无明显差异。所有患者共累及143支冠状动脉临界病变,其中左前降支84支,左回旋支29支,右冠状动脉30支,三组之间SSS值、SDS值、SRS值无明显差异（P>0.05）。冠状动脉临界病变患者中,轻度狭窄患者与中度狭窄患者间低、中、高危患者的分布无明显差异。冠状动脉狭窄程度与SSS、SRS及SDS间无相关关系。ATP负荷99mTc-MIBI门控心肌SPECT显像对冠状动脉临界病变患者心肌缺血检出率显著高于动态心电图检出率（76.0%比39.0%,P<0.05）。结论ATP负荷99mTc-MIBI门控心肌SPECT显像可以较准确地对冠状动脉临界病变患者进行危险分层,指导临床治疗。
Aim To explore the value of adenosine triphosphate（ ATP） stress99mTc-Methoxyisobutylisonitri（99 m Tc-MIBI） gated myocardial single-photon tomography（ SPECT） imaging for making risk stratificatioin in the patients with intermediate coronary lesions. Methods In this study,100 patients with intermediate coronary lesions,diagnosed by coronary angiography（ CAG） were involved. The short axis and vertical long axis slices of left ventricular myocardial were divided into 17 segments by ATP stress99mTc-MIBI gated myocardial SPECT examination. We evaluated radionuclide distribution of each segment sections of left ventricular myocardium with semiquantitative visual method,calculated summed stress score（ SSS）,summed rest score（ SRS）,summed difference score（ SDS）,and ischemia segment number of left ventricular,analyzed the severity myocardial ischemia,and made risk stratificatioin,compared with the severity and vessel narrowness of intermediate coronary lesions. Results A total of 100 patients with intermediate coronary lesions were enrolled in this study,including 62 patients with single intermediate coronary lesion,33 patients with double-vessel lesions,and 5 patients with three. The risk stratification of patients with intermediate coronary lesions was divided into 45 cases（ 45.0%） in low risk group,34 cases in middle risk group（ 34.0%） and 21 cases in high risk group（ 21.0%）.The proportion of high-risk patients in multi-vessel disease group was higher,SSS and SDS were higher than those in singlevessel disease group. And there were significant differences of SSS and SDS between the two groups（ P<0.05）,but there was no significant difference of SRS（ P>0.05）. All patients had a total of 143 intermediate coronary lesions,including 84 LADs,29 LCXs,30 RCAs. SSS,SDS,SRS were not significantly different between the three groups（ P>0.05）. There was no significant difference in risk stratificatioin between patients with mild stenosis and moderate stenosis. Narrowness has no corre
出处
《中国动脉硬化杂志》
CAS
2018年第6期626-632,共7页
Chinese Journal of Arteriosclerosis
关键词
三磷酸腺苷
99m锝-甲氧基异丁基异腈
心肌SPECT显像
冠状动脉临界病变
危险分层
Adenosine triphosphate
99mTc-Methoxyisobutylisonitri
Myocardial single-photon tomography imaging
Intermediate coronary lesions
Risk stratificatioin
