氧甲吡嗪在糖尿病患者^(18)F-FDG心肌代谢显像中的作用  

Feasibility of ^(18)F-FDG myocardial metabolism imaging following oral acipimox in patients with diabetes mellitus

作　　者：沈锐[1] 刘秀杰[1] 史蓉芳[1] 田月琴[1] 魏红星[1] 郭风[1] 何作祥[1] 

机构地区：[1]中国医学科学院,中国协和医科大学阜外心血管病医院核医学科,北京100037

出　　处：《中华核医学杂志》2005年第4期224-227,i0005,共5页Chinese Journal of Nuclear Medicine

摘　　要：目的评价氧甲吡嗪(商品名乐脂平)对改善糖尿病患者心肌18F-脱氧葡萄糖(FDG)摄取的作用。方法107例糖尿病患者进行心肌99Tcm-甲氧基异丁基异腈(MIBI)/18F-FDG双核素同时采集(DISA)SPECT显像,其中65例以口服葡萄糖法进行DISA显像(A组),42例为口服氧甲吡嗪(250mg×2)加口服葡萄糖法显像(B组)。另有8例单纯用口服葡萄糖法图像质量差,而再行另一次口服氧甲吡嗪(250mg×2)加口服葡萄糖法显像。由2位核医学科医师独立评判图像质量(0-3分法,0分为心肌不摄取18F-FDG,1分为心肌少量摄取,2分为心肌摄取,3分为摄取极佳);定量分析心肌与心腔内放射性计数比值(M/B),心脏与肝脏(H/Li)及心脏与右肺中段最大放射性计数比值(H/L)。结果A、B组患者的临床情况相似,18F-FDG注射前血糖浓度没有差别。B组患者没有出现明显副作用。图像质量评分A组为2.3±0.9,B组为2.8±0.7(P=0.013)。口服氧甲吡嗪后,图像达3分的比率明显增加(55.3%比79.5%,P<0.001)。8例进行2次显像的患者,服用氧甲吡嗪后.图像评分由0.50±0.27增加到1.75±0.3l(P=0.009),M/B(分别为1.41±0.31和1.98±0.88,P=0.008)和H/L(分别为0.98±0.18和1.58±0.41,P=0.046)均有明显增加。结论氧甲吡嗪可明显改善糖尿病患者心肌18F-FDG显像的图像质量。Objective To evaluate the feasibility of oral aeipimox, a nicotinic-acid derivative to improve the uptake of ^18 F-fluorodeoxyglucose （FDG） in patients with diabetes mellitus （DM）. Methods 107 patients with DM underwent myocardial ^99Tc^m-methoxyisobutylisonitrile （MIB1） and ^18F-FDG dual isotope simultaneous acquisition （DISA） SPECT. 65 patients underwent DISA SPECT imaging after oral glucose load （group A） , and 42 patients （group B） underwent DISA imaging following the oral administration of acipimox （250 mg × 2）. 8 patients with DM who had poor myocardial ^18F-FDG uptake on myocardial SPECT after standard oral glucose loading had repeat the ^18F-FDG myocardial SPECT following oral administration of acipimox （ 250 mg × 2 ）. Same imaging acquisition and processing protocol were used. Imaging quality was visually assessed using a 4 score system （0 = no myocardial ^18F-FDG uptake, 1 = mild ^18F-FDG up- take, 2 =significant ^18F-FDG uptake, 3 = excellent ^18F-FDG uptake）. Myocardium-to-blood （M/B）, myocardium-to-liver （H/Li） and myocardium-to-the middle of right lung （H/L） ratios were calculated using a region of interest technique. Results Baseline characteristics of the two groups were comparable. Mean plasma glucose concentration before ^18F-FDG injected was similar between the two groups [ （ 11.2 ± 1.9 ） mmol/L vs （10.6 ± 1.9） mmol/l, P 〉 0.05 ]. There were no side-effects in group B patients. Mean imaging qualitY score was 2.3 ± 0.9 in group A and 2.8 ± 0.7 in group B （ P = 0.013 ）. The percentage of score 3 imaging increased significantly ,after oral acipimox （79.5% vs 55.3% , P 〈0.001 ）. In 8 patients underwent repeated ^18F-FDG imaging, the mean imaging score increased significantly （0.5±0.27 vs 1. 75 ±0. 31, P =0.009 ） after oral acipimox. The M/B （1.41 ±0.31 vs 1.98 ±0.88, P = 0. 008） and H/L （0.98± 0.18 vs 1. 58 ± 0. 41, P = 0.046）ratios were significantly higher after acipimox than oral glucose loading only. Con

关 键 词：糖尿病 心脏 体层摄影术 发射型计算机 单光子 脱氧葡萄糖 MIBI 乐脂平 ^18F-FDG 心肌代谢显像 糖尿病患者 氧甲吡嗪 

分 类 号：R587.1[医药卫生—内分泌]