门控核素心肌灌注显像判断冠状动脉支架再狭窄的价值  

The value of gated myocardial perfusion imaging for evaluating stent restenosis after percutaneous coronary interventions

作　　者：徐志娜[1,2] 李殿富[1] 李建华[3] 冯建林[3] 程旭[3] 

机构地区：[1]南京医科大学第一附属医院心脏科,南京210029 [2]南京医科大学第一附属医院 [3]南京医科大学第一附属医院核医学科,南京210029

出　　处：《临床心血管病杂志》2009年第4期302-305,共4页Journal of Clinical Cardiology

基　　金：江苏卫生厅2005年度医学科技基金资助项目(No.H200509)

摘　　要：目的:探讨门控核素心肌灌注显像(G-MPI)对冠状动脉(冠脉)支架再狭窄的诊断价值。方法:65例冠脉支架术后3个月以上的患者行两日法负荷/静息99Tcm-甲氧基异丁基异腈(MIBI)G-MPI,所有患者的G-MPI与冠脉造影(CAG)均在同期的1个月内完成,其中先做CAG检查的患者未进行再次血运重建术。以CAG为标准,分析G-MPI诊断冠脉支架再狭窄的价值。结果:65例患者的88支冠脉共置入105枚支架,随访CAG发现38.5%(25/65)的患者出现支架再狭窄,发生再狭窄的支架数为29.5%(31/105);根据典型症状诊断支架再狭窄的敏感性、特异性和准确性分别为64.0%、22.5%、38.5%;心电图运动平板试验(ETT)诊断支架再狭窄的敏感性、特异性、准确性分别为41.2%、71.9%、61.2%;G-MPI诊断支架再狭窄的敏感性、特异性、准确性分别为92.9%、86.7%、88.6%,其准确性明显优于ETT(χ2=14.173,P<0.001)和症状(χ2=42.781,P<0.001)。结论:G-MPI诊断冠脉支架术后再狭窄具有良好的价值。Objective：To investigate the value of gated myocardial perfusion imaging for evaluating stent restenosis following coronary stent implantation. Method：Sixty-five patients of CAD with stent implantation were envolled to assess restenosis and all patients underwent stress/rest ^99Tc^m-MIBI G -MPI within more than 3 months after PCI. Coronary angiography （CAG） was performed within 1 month before or after G-MPI test and target lesion revascularization were not performed if CAG was performed before G-MPI . The results of G-MPI were compared with CAG. Result： The stents were deployed in 88 coronary arteries in 65 patients （105 stents）. There were 25 （38.5 %） patients, 31 （29.5%） stents with restenosis following CAG. The sensitivity, specificity and accuracy of typical symptoms in diagnosing restenosis were 64.0% ,22.5% and 38.5% respectively. The sensitivity, specificity and accuracy of exercise treadmill test（ETT） were 41.20%, 71.9 %and 61.2 %respectively. The sensitivity, specificity and accuracy of G-MPI were 92.9% ,86.7% and 88.6% respectively. The accuracy of G-MPI was obviously superior to ETT（X^2=14. 173, P〈0. 001 ） and symptoms（X^2 = 42. 781, P〈0. 001 ）. Conclusion： G-MPI has high accuracy in diagnosing restenosis.

关 键 词：冠状动脉疾病 支架 再狭窄 甲氧基异丁基异睛 门控心肌灌注显像 

分 类 号：R541.1[医药卫生—心血管疾病]