冠状动脉痉挛患者心电图及^(201)Tl心肌灌注显像负荷试验的特征  

Characteristics of treadmill electrocardiography and dipyridamole ^(201)Tl myocardial perfusion imaging in patients with coronary artery spasm

作　　者：向定成[1] 尹吉林[2] 何建新[1] 滕爱萍[1] 龚志华[1] 马骏[1] 洪长江[1] 邱建[1] 

机构地区：[1]广州军区广州总医院心血管内科,510010 [2]广州军区广州总医院核医学科,510010

出　　处：《中华核医学杂志》2005年第1期10-13,i001,共5页Chinese Journal of Nuclear Medicine

基　　金：广东省自然科学基金资助项目 (0 3 2 186)

摘　　要：目的　探讨冠状动脉痉挛患者心电图运动试验和2 0 1 Tl心肌灌注显像双嘧达莫 (潘生丁 )试验的特征及非创伤性检测冠状动脉痉挛的理想方法。方法　以临床上 5 2例具有胸痛、冠状动脉造影无显著狭窄而接受乙酰胆碱试验的患者为研究对象 ,进行心电图活动平板运动试验和2 0 1 Tl心肌灌注显像双嘧达莫试验 ,探讨其试验结果与冠状动脉痉挛的关系。结果　 5 2例受检者中阳性即冠状动脉痉挛患者 4 2例 ,多以静息性胸闷为主 ,不同于冠状动脉狭窄所引起的劳累性胸痛 ;1 0例阴性患者多以与活动和休息无关的刺痛为主。心电图运动试验阳性 3例。 5 2例患者中 4 8例2 0 1 Tl心肌灌注显像呈反向再分布。单纯反向再分布预测冠状动脉痉挛的灵敏度和特异性分别为 1 0 0 %和 4 0 %;而以同时具备静息性胸闷、运动试验阴性和反向再分布 3个特征预测冠状动脉痉挛的灵敏度和特异性分别为 98%和 90 %。结论　反向再分布可能是冠状动脉痉挛的特征之一 ;同时具备静息性胸闷、运动试验阴性和反向再分布是预测冠状动脉痉挛较理想的非创伤性方法。Objective To investigate the characteristics of treadmill electrocardiography and dipyridamole 201 Tl myocardial perfusion imaging in patients with coronary artery spasm, and to explore a non invasive procedure for diagnosing coronary artery spasm. Methods The patients who had chest pain but no significant coronary artery stenosis and were willing to undergo acetylcholine test were included. Treadmill electrocardiography, dipyridamole and rest 201 Tl myocardial perfusion computed tomography were performed before or after coronary angiography. The relationship between the results of above mentioned stress tests and coronary spasm was investigated. Results Acetylcholine test was performed on all the 52 patients and provoked coronary artery spasm in 42 patients of them. Rest chest pain with oppression was clinically remarkable in those patients with coronary artery spasm, which was different from effort chest pain in patients with significant coronary stenosis, but twinge without stable relation to effort or rest was the main clinical manifestation in non spasm and non stenosis patients. Ischemic change on electrocardiogram was induced during treadmill electrocardiography in only 3 patients of the study group and no ischemic changes in the remaining 49 patients. Reverse redistribution on 201 Tl myocardial perfusion imaging was noticed in 48 patients. The sensitivity and specificity of predicting coronary artery spasm by reverse redistribution were 100% and 40%, respectively. To predict coronary artery spasm by combination of reserve redistribution, rest chest pain with oppression and negative treadmill electrocardiogram, the sensitivity remained at 98% but the specificity increased to 90%. Conclusions Reserve redistribution might be one of the characteristics of coronary artery spasm. The combination of reserve redistribution, rest chest pain with oppression and negative treadmill electrocardiogram might be a rational non invasive method to predict coronary artery spasm.

关 键 词：冠状动脉痉挛 患者 心电图运动试验 心肌灌注显像 胸闷 阴性 胸痛 特征 结论 研究对象 

分 类 号：R444[医药卫生—诊断学] R817.4[医药卫生—临床医学]