用腺苷负荷心肌灌注显像评价高血压患者冠状动脉血流储备  

Assessment of coronary flow reserve by adenosine stress myocardial perfusion imaging in patients with hypertension

作　　者：傅强[1] 王跃涛[2] 黄宜杰 王彦炯[1] 吴强[1] 鹿存芝[2] 

机构地区：[1]徐州市心血管病研究所,徐州市第四人民医院心内科,221009 [2]徐州市心血管病研究所,徐州市第四人民医院核医学科,221009

出　　处：《中华核医学杂志》2004年第6期350-352,i003,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的　用腺苷负荷心肌灌注显像评价高血压患者冠状动脉 (简称冠脉 )血流储备(CFR)。方法　冠脉造影正常的高血压患者 4 7例 ,其中无左心室肥厚 (LVH) 2 5例 ,合并LVH 2 2例 ;正常对照组 17例。分别行静息及腺苷负荷心肌灌注显像。结果　腺苷负荷心肌灌注显像高血压组呈缺血性改变 2 6例 (5 5 3% ) ,对照组 1例 (5 9% ,χ2 =31 12 ,P <0 0 0 1) ;高血压组共 87个节段(2 0 6 % )呈放射性异常分布 ,对照组有 1个节段 (0 7% ,χ2 =32 90 ,P <0 0 0 1)。高血压组自身前后对照 :腺苷注射前心肌灌注显像有 6例 (12 8% )呈缺血性改变 ,共 14个节段 (3 3% ) ;腺苷负荷后 2 6例 (5 5 3% )呈缺血性改变 (χ2 =6 96 ,P <0 0 0 1) ,共 87个节段 (2 0 6 % )呈放射性异常分布 (χ2 =5 9 92 ,P <0 0 0 1)。LVH组腺苷负荷心肌灌注显像呈缺血性改变 17例 (77 3% ) ,无LVH组 9例(36 0 % ,χ2 =8 0 6 ,P <0 0 1) ,LVH组共 6 7个节段 (33 8% )呈放射性异常分布 ,无LVH组为 2 0个节段 (8 9% ,χ2 =4 0 13,P <0 0 0 1)。结论　腺苷负荷心肌灌注显像评价高血压患者CFR安全、易行 ;高血压患者CFR明显异常 ,合并LVH者更为明显。Objective To assess the coronary flow reserve (CFR) by performing adenosine stress 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT myocardial perfusion imaging on patients with hypertension. Methods Forty-seven hypertensive patients with normal coronary angiography were divided into 2 groups, according to whether the patients were with left ventricular hypertrophy (LVH, n=22) or without left ventricular hypertrophy (non-LVH, n=25); 17 normal subjects were selected as control. All cases received adenosine stress-rest 99Tcm-MIBI scintigraphy. Adenosine was administered at a dose of 0.14 mg·kg -1·min -1 by continuous infusion for 6 min. Results SPECT perfusion imaging showed that adenosine induced myocardial ischemia, there were 26 cases (55.3%), 87 segments (20.6%) that showed abnormal distribution in hypertensive group and 1 case (5.9%, χ2=31.12, P<0.001), 1 segment(0.7%,χ2=32.90, P<0.001) in control group.In the LVH group,there were 17 cases (77.3%), 67 segments (33.8%).In the non-LVH group,there were 9 cases (36.0%,χ2=8.06, P<0.01), 20 segments(8.9%,χ2=40.13, P<0.001). Comparing the cases and segments presented myocardial ischemia before and after adenosine infusion in 47 cases with hypertension, there were 6 cases (before, 12.8%) vs 26 cases (after, 55.3%, χ2=6.96, P<0.001), 14 segments (before, 3.3%) vs 87 segments (after, 20.6%, χ2=59.92, P<0.001). Conclusions The study suggests that assessing CFR with 99Tcm-MIBI adenosine stress SPECT imaging is a safe and easy method to be used in patients with hypertension. CFR was decreased in patients with hypertension, and this decrease was especially remarkable in hypertensive patients with LVH.

关 键 词：心肌灌注显像 腺苷 LVH 高血压患者 缺血性 改变 对照组 结论 合并 目的 

分 类 号：R544.1[医药卫生—心血管疾病] R541[医药卫生—内科学]