阿托品-4min腺苷负荷心肌灌注显像对冠心病的临床诊断价值  

Clinical value of atropine-four minutes adenosine stressed ^99Tc^m-MIBI myocardial perfusion imaging in the diagnosis of coronary artery disease

作　　者：彭旭兰[1] 张宝牛[1] 江素芳[1] 梁宏伟[1] 刘炯[1] 高桂珠[1] 丁明辉[1] 侯军夫[1] 

机构地区：[1]山西医科大学第二医院核医学科,太原 030001

出　　处：《中华核医学杂志》2008年第1期39-42,共4页Chinese Journal of Nuclear Medicine

基　　金：山西省卫生厅科技项目（200409）.

摘　　要：目的评价阿托品-4min腺苷负荷试验心肌灌注显像对冠心病的临床诊断价值。方法将研究对象按性别、年龄、冠心病的严重程度[依据冠状动脉（简称冠脉）造影结果]及合并症等进行配对，分为阿托品-4min腺苷负荷组（研究组）和6min腺苷负荷组（对照组），每组28例。研究组在注射腺苷前10min静脉注射阿托品0．5mg。2组病例分别经肘静脉用注射泵持续注入腺苷，剂量为按体质量0．14mg·kg^-1·min^-1，用药时间为4和6min，于注射腺苷3min末，分别从肘静脉注入^99Tc^m-甲氧基异丁基异腈（MIBI）740MBq。腺苷负荷心肌灌注显像在注射显像剂后1．5h进行，隔日进行静息心肌灌注显像。结果（1）研究组和对照组腺苷负荷心肌显像诊断冠心病心肌缺血的灵敏度、特异性、准确性分别为85％，6／8，82％和86％，5／7，82％，2组比较r均〈0．001，P均〉0．05。（2）研究组腺苷负荷试验诊断单支、双支、三支冠脉狭窄病变的灵敏度分别为6／7，8／9和3／4，对照组分别为7／8，7／8和4／5，组间比较矿均〈0．001，P〉0．05。（3）研究组和对照组不良反应总的发生率分别为82％和89％；2组各不良反应发生率除胸闷（43％和68％）差异有统计学意义（r=4．000，P〈0．05）以外，其余表现2组比较差异均无统计学意义。结论阿托品-4min腺苷负荷心肌灌注显像对冠心病心肌缺血有较高的诊断价值，可达到6min腺苷负荷试验的诊断效能，且胸闷发生率低，更安全简便。Objective The aim of this＇study-was to compare the diagnostic efficacy of atropine-4 rain adenosine stressed ^99Tc^m-methoxyisobutylisonitrile （MIBI） myocardial perfusion imaging in the diagnosis of coronary artery disease（CAD）. Methods A total of 56 patients were divided into atropine-4 rain a- denosine stress（ research group） and 6 rain adenosine infusion （control group）. The sex, age, the severity of CAD （judged by coronary angiography） and associated symptoms were matched between the 2 groups. In research group, 0.5 mg atropine was injected intravenously 10 min before adenosine infusion. Adenosine was infused at a rate of 0.14 mg · kg^-1· min^-1 intravenously for 4 min and 6 min in research and control groups. At 3 min after adenosine infusion, 740 MBq ^99Tc^m-MIBI was injected. SPECT myocardial imaging was obtained 1.5 h later. A rest myocardial perfusion imaging was performed on the following day. Results （1）In research group and control group, the sensitivity, specificity, diagnostic accuracy was 85%, 6/8, 82% and 86% , 5/7, 82% , respectively （χ^2 〈 0. 001, P 〉 0.05 ）. （ 2 ） The sensitivity of the adenosine test for detection of single vessel, two vessels, three vessels disease were 6/7, 8/9, 3/4 and 7/8, 7/8, 4/5 in research group and control group, respectively（χ^2 〈0. 001, P 〉0.05）. （3） Side affects occurred in 82% of the patients in the research group and in 89% of the patients in the control group. The incidence of side effects in the two groups was not significantly different besides chest depression （43% and 68%, X2 = 4. 000, P 〈 0.05 ）. Conclusions Atropine-4 min adenosine infusion, in combination with perfusion tomography, has similar diagnostic efficacy for CAD to the 6 min protocol, and has lower incidence of chest depression than the standard 6 min infusion.

关 键 词：冠状动脉疾病 体层摄影术 发射型计算机 单光子 阿托品 腺苷 MIBI 

分 类 号：R686[医药卫生—骨科学]