GIK介入^(201)Tl与^(99m)Tc-MIBI心肌灌注断层显像判定陈旧性心肌梗塞病人存活心肌的对比研究  

Detection of hibernating myocardium in patients with old myocardial infarction by 201 Tl glucose insulin potassium or 99m Tc MIBI glucose insulin potassium myocardial SPECT imaging

作　　者：殷宝玲[1] 王铁[1] 张金谷[1] 武秀朵[1] 郑柏洁[1] 崔志澄[1] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院综合科

出　　处：《中华核医学杂志》1997年第2期83-85,共3页Chinese Journal of Nuclear Medicine

摘　　要：为评价１０％葡萄糖２５０ｍｌ＋胰岛素５Ｕ＋氯化钾１０ｍｍｏｌ（ＧＩＫ）介入２０１Ｔｌ与９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌灌注断层显像（ＳＰＥＣＴ）估测心肌梗塞病人存活心肌的可靠性，将２０１Ｔｌ或９９ｍＴｃＭＩＢＩ加入ＧＩＫ溶液中，静脉滴注后行心肌ＳＰＥＣＴ。采用圆周剖面法进行定量分析，以存活分数为判断指标，估测２８例陈旧性心肌梗塞病人的存活心肌。全部病人均进行了静态心肌、２０１ＴｌＧＩＫ与９９ｍＴｃＭＩＢＩＧＩＫ心肌ＳＰＥＣＴ；有１１例于经皮腔内冠状动脉成形术（ＰＴＣＡ）术后１周，４例于冠状动脉搭桥术（ＣＡＢＧ）后２周复查了静态心肌ＳＰＥＣＴ。结果：２８例病人总共３３６个心室节段中，静态心肌ＳＰＥＣＴ示１１９个节段梗塞。２０１ＴｌＧＩＫ显像有４５个节段（３７８％）灌注改善（存活分数＞０２），９９ｍＴｃＭＩＢＩＧＩＫ显像有４７个节段（３９５％）灌注改善，两者间差异无显著性（χ２＝０２５，Ｐ＝０６２），一致性为８７％（Ｋ＝０７２）。２０１ＴｌＧＩＫ和９９ｍＴｃＭＩＢＩＧＩＫ显像与冠状动脉成形术后显像的符合率分别为８７５％和８４４％。因此，ＧＩＫ介入２０１Ｔｌ或９９ｍＴｃＭＩＢ?PURPOSE To evaluate and compare the reliability of 201 Tl glucose insulin potassium (GIK) and 99m Tc MIBI GIK myocardial SPECT imaging for detection of viable myocardium in patients with old myocardial infarction (OMI) METHODS 201 Tl or 99m Tc MIBI was mixed in GIK solution (10% glucose 250ml, insulin 5U and potassium chloride 10mmol) Myocardial SPECT imaging was performed after infusion It was analysed with Circumferential Profile method All patients performed rest, 201 Tl GIK and 99m Tc MIBI GIK myocardial SPECT imaging One week after PTCA in 11 cases and two weeks after CABG in 4 cases, rest myocardial SPECT imaging was performed again RESULTS In all 336 segments of 28 patients, there were 119 infarction segments in rest SPECT In 201 Tl GIK SPECT, the perfusion of 45 segments (37 8%) was improved (viable score>0 2), whereas in 99m Tc MIBI SPECT, that of 47 segments (39 5%) was improved Both were no significant difference (χ 2=0 25, P=0 62) Their coincidence rate was 87%(Κ=0 72) The coincidence rate of 201 Tl GIK and 99m Tc MIBI GIK SPECT were 87 5% and 84 4% respectively after PTCA imaging CONCLUSIONS Myocardial SPECT imaging after infusion of 201 Tl GIK or 99m Tc MIBI GIK was used to detect viable myocardium in patients with OMI Good correlation was observed between them Besides, this method was safe, reliable and easy to identify viable myocardium

关 键 词：心肌梗塞 铊201 锝99M 

分 类 号：R542.22[医药卫生—心血管疾病]