ATP负荷与运动负荷心肌灌注断层显像对冠心病的诊断价值  

Direct comparison of adenosine triphosphate infusion and exercise stress myocardial perfusion tomography in diagnosis of coronary artery disease

作　　者：张瑞生[1] 屈婉莹[2] 何青[1] 姚稚明[2] 孙福成[1] 许锋[1] 

机构地区：[1]卫生部北京医院心内科,100730 [2]卫生部北京医院核医学科,100730

出　　处：《中华核医学杂志》2004年第4期229-232,i002,共5页Chinese Journal of Nuclear Medicine

基　　金：卫生部保健局保健科研基金资助项目 (0 0 3)

摘　　要：目的　探讨ATP负荷心肌灌注断层显像 (ATP MPI)诊断冠心病 (CAD)的价值。方法　6 1例无心肌梗死病史的疑诊CAD患者 ,均在不同时间分别行静息、ATP负荷及运动负荷99Tcm 甲氧基异丁基异腈 (MIBI)心肌灌注断层显像 (一日法静息 ATP、隔日运动或一日法静息 运动、隔日ATP ,分别简称为ATP MPI和ST MPI) ,其中 4 6例行冠状动脉造影。结果　ATP MPI诊断CAD的灵敏度、特异性和准确性分别为 90 9% ,91 7%和 91 3% ,ST MPI分别为 86 4 % ,91 7%和 89 1% ,差异无显著性(P >0 0 5 )。ATP MPI检测冠状动脉血管狭窄的灵敏度、特异性和准确性分别为 84 6 % ,86 9%和86 2 % ,ST MPI则分别为 84 6 % ,84 8%和 84 8% ,差异无显著性 (P >0 0 5 )。ATP负荷试验时不良反应发生率明显高于运动负荷试验 (88 5 %vs 5 4 1% ,χ2 =17 6 6 9,P <0 0 1) ,但均轻微而短暂 ,恢复时间明显短于后者。结论　ATP MPI诊断CAD的价值与ST MPI相似。ATP负荷试验安全性与耐受性良好 ,尤其适用于老年、无法运动和高血压患者。Objective To compare the clinical effects of adenosine triphosphate (ATP) and exercise stress using 99 Tc m-methoxyisobutylisonitrile (MIBI) SPECT imaging for detecting coronary artery disease (CAD) in identical CAD patient group. Methods Sixty-one patients suspected with CAD underwent 99 Tc m-MIBI myocardial perfusion tomographic imaging (MPI) at rest,and symptom-limited multistage exercise,or intravenous ATP (0.16 mg·kg -1 ·min -1 for 5 min) separately one day after the rest imaging. Forty-six of them also underwent coronary angiography. Results The sensitivity,specificity and accuracy of ATP-MPI and ST-MPI in detection of CAD were 90.9%,91.7%,91.3% and 86.4%, 91.7%,89.1%,respectively;and those in detection of ≥50% narrowing coronary artery were 84.6%,86.9%,86.2% and 84.6%,84.8%,84.8%,respectively. Side effects during ATP stress test occurred more frequently than that during exercise test (88.5% vs 54.1%,χ 2=17.669,P<0.01),but all the adverse effects were mild and transient. Allopathy or interruption of ATP stress did not happen. Conclusion ATP-MPI is an accurate,safe modality and is comparable to ST-MPI for detecting CAD.

关 键 词：ATP 诊断价值 心肌灌注断层显像 冠心病 特异性 运动 ^99TC^M-甲氧基异丁基异腈 MPI CAD ST 

分 类 号：R541.4[医药卫生—心血管疾病] TP391[医药卫生—内科学]