用双核素心肌断层显像评价Q波和非Q波心肌梗死存活心肌  

Study of viable myocardium in non Q-wave myocardial infarction and Q-wave myocardial infarction with dual isotope SPECT myocardial imaging

作　　者：程旭[1] 黄钢[1] 李殿富[3] 陶如琦[2] 徐兆强[4] 刘建平[2] 刘建军[1] 吴锦昌[4] 

机构地区：[1]上海第二医科大学附属仁济医院核医学科,200001 [2]上海第二医科大学附属仁济医院心脏科 [3]南京医科大学第一附属医院心脏科,核心脏病学研究室,200001 [4]南京医科大学第一附属医核医学科

出　　处：《中华核医学杂志》2005年第1期7-9,共3页Chinese Journal of Nuclear Medicine

基　　金：上海市科委重点基金资助项目 (0 3 411982 3 ) ;上海市卫生局百人计划第三轮重点资助项目 (97BR0 12 )

摘　　要：目的　利用99Tcm 甲氧基异丁基异腈 (MIBI) 1 .8F 脱氧葡萄糖 (FDG)双核素心肌断层显像评价Q波和非Q波心肌梗死 (MI)患者中存活心肌的情况。方法　 4 .5例MI患者分为无Q波MI(NQMI,n =1 7)和有Q波MI(QMI,n =2 8) 2组。均行99Tcm MIBISPECT门控心肌灌注显像、1 .8F FDGSPECT心肌代谢显像和冠状动脉造影。根据心肌血流灌注、代谢和门控信息等比较 2组患者存活心肌的情况。结果　NQMI组的缺血存活心肌节段数明显高于QMI组 ,非存活心肌节段数明显低于QMI组 (P值分别为 0. 0 0 1和 0. 0 0 5 ) ;左室射血分数 (LVEF)明显高于QMI组 (t =4 . 6 0. 3,P =0. 0 0 0 )。门控分析所得室壁增厚率和缺血存活心肌间存在良好相关性 (r=0 . 6 71 ,P =0. 0 0 0 ) ,NQMI组室壁增厚率降低的节段数明显低于QMI组 (t=4 . 1 83,P =0 . 0 0 0 )。结论　对NQMI患者采取更积极的治疗策略有助于挽救更多的缺血存活心肌 ,改善其预后。Objective To investigate ischemic viable myocardium in patients with non Q wave myocardial infarction(NQMI) and patients with Q wave myocardial infarction(QMI) by gated SPECT with dual isotope, 99 Tc m methoxyisobutylisonitrile (MIBI) and 18 F fluorodeoxyglucose (FDG). Methods Forty five patients with previous myocardial infarction were included in this study and were divided into NQMI group( n =17) and QMI group( n =28). All patients underwent 99 Tc m MIBI gated myocardial perfusion imaging, 18 F FDG SPECT myocardial imaging and coronary angiography. Results Ischemic viable myocardium was more common in NQMI group than in QMI group (100% ∶ 71%, P =0.017). The segments of ischemic viable myocardium were significantly more in NQMI group than in QMI group ( P =0.001) and non viable segments were significantly fewer in NQMI group than in QMI group ( P =0.005). The value of left ventricular ejection fraction (LVEF) was significantly higher in NQMI group than in QMI group ( P =0.000). There was good correlation between wall thickening and ischemic viable myocardium( r =0.671, P =0.000). The segments with abnormal wall thickening were significantly more in QMI group than in NQMI group ( P =0.000). Conclusion The study suggests that aggressive approaches should be taken to salvage the myocardium in NQMI patients.

关 键 词：存活心肌 NQMI 患者 非Q波心肌梗死 心肌断层显像 缺血 SPECT 结论 情况 信息 

分 类 号：R817.4[医药卫生—影像医学与核医学]