^(99m)Tc-MIBI 心肌断层显像进行急性心肌缺血冠脉再通术早期评价的实验研究  

The value of serial 99m Tc-MIBI myocardial SPECT imaging in animal models of acute myocardial ischemia and reperfusion

作　　者：田嘉禾[1] 刘宏斌[1] 何国荣 张锦明[1] 尹大一[1] 刘自来[1] 李天德[1] 王思让[1] 

机构地区：[1]中国人民解放军总医院

出　　处：《核技术》1997年第11期641-646,共6页Nuclear Techniques

摘　　要：通过动物模型验证系列心肌灌注显像判断急性缺血后再灌注心肌挽救的价值。将２４只狗模拟临床急性心肌缺血冠脉再通术后转归，分为缺血－有效心肌挽救（Ⅰ）组、缺血－延迟再通（Ⅱ）组和缺血－无再通（Ⅲ）组。所有动物接受缺血当时，灌注重建后即刻，之后７天、１４天及２８天系列９９ｍＴｃ－ＭＩＢＩ断层显像。在极座标靶心图上求出各次显像时心肌缺损分数（ＤＦ），并与病理证实心肌缺血分数（ＩＦ）、心肌梗塞分数（ＮＦ）对比。结果Ⅰ组从第２次显像起，ＤＦ持续下降；Ⅱ组ＤＦ下降程度小；Ⅲ组ＤＦ无降低。首次显像的ＤＦ与ＩＦ相关良好；末次显像ＤＦ与ＮＦ相关。再灌注后，即刻与再灌注前ＤＦ差在三组动物间有明显差别，并与每组动物的最后结果趋势一致。表明系列９９ｍＴｃ－ＭＩＢＩ显像可以准确、及时反映缺血－再灌注后心肌实际状态；缺血当时显像的ＤＦ显示缺血影响范围，而数周后显像ＤＦ反映坏死心肌大小；再灌注后即刻显像可提供准确、可靠的介入响应及预后的信息；冠脉介入前、后，及３—４周后显像的临床实用价值最为明确。he purpose of this paper is to evaluate acute ischemia and reperfusion in canine models by serial 99m Tc-MIBI myocardial SPECT studies. In 24 dogs, myocardial ischemia was induced by dilated balloon inserted in LAD or LCX, followed by reperfusion at 1h (GroupⅠ), 4h (Group Ⅱ) later, and permanent ischemia by copper coil(Group Ⅲ). The first and second imaging was taken after ischemia and after reperfusion. The 3rd, 4th and 5th SPECT were at 7, 14 and 28 days later. Defect fraction(DF), and ischemic fraction(IF) was obtained from the Bull′s-eye images. The first DFs in all 3 groups correlated well with the myocardium at risk(IF) measured by pathological study. DF in group Ⅰ decreased censistently since the second SPECT, in Group Ⅱ DF had some decrease, while in Group Ⅲ no decrease of DF was measured. The SF in all animals showed the same trend. The last DF was correlated with the real size of infarct foci(NF) determined by TTC staining by pathological study. 99m Tc-MIBI SPECT was sensitive and accurate in revealing myocardial damage after acute ischemia and its response to reperfusion. The first(before), seconed(right after), and the last SPECT(4 weeks after reperfusion) were the most informative and clinically useful.

关 键 词：心肌缺血 介入治疗 冠脉再通 断层显像 锝99M 

分 类 号：R816.2[医药卫生—放射医学] R542.2[医药卫生—临床医学]