^(99m)Tc-MIBI门控心肌断层显像在冠状动脉支架术后的临床价值  

Clinical value of ～(99m)Tc-MIBI gated cardiac SPECT imaging in patients undergoing percutaneous transluminal coronary angioplasty plus stent implantation

作　　者：冯建林[1] 李殿富[2] 程旭[1] 李建华[1] 付昌文[1] 付裕[1] 

机构地区：[1]南京医科大学第一附属医院核医学科,江苏南京210029 [2]南京医科大学第一附属医院心脏科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2006年第9期761-763,768,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生厅2005年度医学科技发展基金资助(H200509)

摘　　要：目的:探讨99mTc-甲氧基异丁基异腈(MIBI)门控心肌断层显像(G-MPI)在冠状动脉支架术后疗效评价、判断再狭窄以及预后评估的临床价值。方法:78例患者,冠状动脉支架术后3～12个月内均行G-MPI,其中31例有术前对照。33例复查冠状动脉造影(CAG)。随访13～24个月。结果:①31例复查G-MPI24例心肌灌注有改善,改善率为77.4%。②31例术后静息G-MPI所测左室射血分数(LVEF)较术前由(42.6±8.6)%上升至(49.7%±6.4)%,P<0.05;舒张末期容积(EDV)和收缩末期容积(ESV)分别由(158.2±55.3)ml、(92.6±44.9)ml明显下降到(133.9±39.9)ml、(71.2±28.7)ml,P均<0.01。③33例复查CAG患者,G-MPI对再狭窄诊断的敏感性、特异性、准确性为82.3%、85.0%、84.8%。④随访心脏事件发生率术后G-MPI灌注改善组(1.9%)与异常组(28.6%)之间有极显著差异(P<0.01)。结论:G-MPI对冠心病血运重建术后疗效评价、判断再狭窄以及预后评估具有重要的临床价值。Objective：To assess the value of ^99mTc-methoxyisobutylisonitrile （MIBI） gated myocardial perfusion imaging （G-MPI） for evaluation of perfusion improvement, prediction of restenosis and cardiac event rate in patients undergoing successful stent implantation. Methods：Seventy-eight patients underwent G-MPI 3-12 months after operation. G-MPI was also performed in 31 patients before operation, and 33 patients underwent coronary angiography （CAG）. The patieuts were followed up for 13-24 months. Results： ① Among 31 patients, perfusion imaging was improved in 24 cases, and the improved rate was 77.4%. ②LVEF was increased from（42.6 ± 8.6）% to （49.7% ± 6.4）%,P 〈 0.05; EDV and ESV were decreased significantly [（158.2 ＋ 55.3） ml vs （133.9 ± 39.9） ml, and （92.6± 44.9） ml vs （71.2±28.7） ml, P 〈 0.01, respectively]. ③Restenosis was detected in 33 patients. Sensitivity,specificity and accuracy rates of G-MPI for predicting restenosis were 82.3%, 85.0%, 84.8%. ④During the follow-up, the incidence rate of cardiac events in non-ischemic group was significantly lower than that in abnormal group （1.9% vs 28.6%, χ^2 = 12.95,P 〈 0.01）. Conclusion：G-MPI is an excellent tool to evaluate the effects of stent implantation and to predict restenosis, and cardiac events.

关 键 词：冠状动脉疾病 经腔 经皮冠状动脉 血管成形术 门控心肌断层显像 

分 类 号：R445[医药卫生—影像医学与核医学]