负荷超声结合心肌背向散射对比负荷核素检查评价存活心肌的研究  

Dobutamine Stress Echocardiography Combined with Integrated Backscatter for Evaluating Viable Myocardium in Patients with Coronary Artery Disease:A comparison with Nitroglycerin Mediated Stress 99m Tc Single Photon Emission Computorized Tomography

作　　者：李东野[1] 常超[1] 夏勇[1] 钱文浩[1] 陈静[1] 王晓萍[1] 徐通达[1] 

机构地区：[1]徐州医学院心血管研究所附属医院心内科,江苏省徐州市221002

出　　处：《中国超声医学杂志》2005年第5期340-344,共5页Chinese Journal of Ultrasound in Medicine

基　　金：江苏省科技厅应用基础研究项目(No.BJ20000590)

摘　　要：目的探讨多巴酚丁胺负荷超声(DSE)结合心肌背向散射积分(IBS)检测存活心肌的临床应用价值。方法对照(CON)组18例患者,冠状动脉定量造影术(QCA)正常。行二维超声(2DE)、DSE结合IBS检查。冠心病(AD)组22例患者,经QCA确诊为冠心病。并行经皮冠脉介入治疗术(PCI),术前1周内行DSE5、10、20、40μg/(kg.min)检查、静息及硝酸甘油(NTG)介入99mTc-甲氧基异丁基异腈单光子发射计算机断层灌注显像(SPECT)检查,于静息、DSE每级负荷5min采集全心尖切面(长轴、二腔、四腔)IBS图像,术后(3个月)复查二维超声。探索在DSE过程中,以CVIB最大变化率(K)>1.3定义为存活心肌,检测其识别存活心肌的准确性,并与常规DSE、SPECT进行比较。结果与常规DSE相比,DSE结合IBS技术检测存活心肌敏感性、准确性明显提高(90.0%vs73.3%;90.4%vs77.4%、P<0.05～0.01);与SPECT相比敏感性、特异性、准确性均明显提高(90.0%vs80.0%;92.0%vs64.0%;90.4%vs76.5%,P<0.05～0.01)。结论DSE结合IBS技术检测存活心肌准确性较SPECT高,具有临床应用价值。Objective To explore the clinical value of dobutamine(Dob) stress echocardiography(DSE) combined with integrated backscatter(IBS) for identifying viable myocardium in patients with coronary artery disease(CAD).Methods Eighteen patients (control group) whose results of the quantitative coronary artery (QCA) were normal underwent the examination of 2-DE,DSE with IBS.In 22 patients who were diagnosed CAD (CAD group) by QCA,percutaneous coronary intervention(PCI) was performed further.DSE 5,10,20,40μg/(kg.min) and rest/NTG modiated SPECT were checked one week before PCI.IBS images at rest and every grade infusion of Dob 5 minutes were obtained in total apical views(Lax,2-ch,4-ch).Two-dimensional echocardiography was examined after three months of PCI again.The maximum changing rate of CVIB (K) during DSE >1.3 was defined as viable myocardium,then the accuracy in identifying viable myocardium were compared among routine DSE,SPECT and DSE combined with IBS.Results The sensitivity,accuracy for identifying viable myocardium were significantly higher by DSE combined with IBS than those of routine DSE ( sensitivity:90.0% vs73.3%,accuracy:90.4 vs 77.4%,respectively P<0.05～0.01).Compared with SPECT,the sensitivity,specificity and accuracy were significantly improved by DSE combined with IBS,ie 90.0%,92.0%,90.4% respectively.Conclusions DSE combined with IBS identifying viable myocardium has higher accuracy than that of SPECT.It is more practical in clinical.

关 键 词：存活心肌 ^99MTC-甲氧基异丁基异腈 检查评价 单光子发射计算机断层 多巴酚丁胺负荷超声 经皮冠脉介入治疗术 心肌背向散射积分 临床应用价值 SPECT 核素 二维超声 技术检测 DSE 准确性 IBS 冠状动脉 灌注显像 硝酸甘油 

分 类 号：R540.4[医药卫生—心血管疾病]