负荷-静息心肌灌注显像对老年人冠心病的诊断价值  

Diagnostic value of stress-rest myocardial perfusion imaging in detection of coronary disease in elderly patients

作　　者：韩萍萍[1] 田月琴[1] 方纬[1] 沈锐[1] 杨敏福[1] 魏红星[1] 郭新华[1] 何作祥[1] 

机构地区：[1]北京协和医学院、中国医学科学院阜外心血管病医院核医学科,100037

出　　处：《中华核医学杂志》2009年第6期365-368,共4页Chinese Journal of Nuclear Medicine

基　　金：国家科技支撑计划课题（2007BAI05B01）

摘　　要：目的探讨负荷-静息心肌灌注显像对老年人冠心病的诊断价值。方法205例疑诊冠心病的老年患者[≥60（67±5）岁]，行^99Tc^m-甲氧基异丁基异腈（MIBI）负荷-静息心肌灌注显像（运动负荷185例，药物负荷20例）和冠状动脉造影检查，排除曾行经皮冠状动脉介入治疗（PCI）及冠状动脉旁路移植术（CABG）者。以冠状动脉造影为“金标准”，评价负荷-静息心肌灌注显像诊断老年冠心病的灵敏度、特异性和准确性。采用SPSS 15．0软件对数据行χ^2检验。结果以冠状动脉管腔狭窄〉50％作为诊断标准，205例患者中冠状动脉造影阳性57例（28％），其中单支病变30例，双支病变19例，三支病变8例。冠状动脉造影结果阳性的患者中核素负荷-静息心肌灌注显像异常者36例；冠状动脉造影阴性148例（72％）患者中，负荷-静息心肌灌注显像正常者135例。对照冠状动脉造影结果，负荷-静息心肌灌注显像对老年人冠心病总的诊断灵敏度63％（36／57），特异性91％（135／148），准确性83％（171／205）；对单支、双支以及三支病变的诊断灵敏度分别为57％（17／30）、58％（11／19）和8／8。行运动负荷显像患者185例，按照运动试验是否达到目标心率分为2组：组1运动试验高峰心率达到目标心率，共53例（29％）；组2运动试验高峰心率未达到目标心率，共132例（71％）。2组心肌灌注显像诊断冠心病的灵敏度分别为81％（13／16）和58％（22／38）。组1诊断灵敏度高于组2，但经χ^2检验，两者之间差异无统计学意义（χ^2=2．69，P=0．1）。结论负荷-静息心肌灌注显像是诊断老年人冠心病的可靠方法；当运动负荷达到目标心率时，核素心肌灌注显像诊断冠心病的灵敏度较高。Objective Coronary artery disease is one of the most common causes of death in elderly people. Yet, definite diagnosis is a dilemma due to the variety of symptoms and signs. The aim of this study was to evaluate the diagnostic value of nuclear stress-rest myocardial perfusion imaging （MPI） in detection of coronary disease in the elderly. Methods Two hundred and five elderly subjects （ ≥60 years old, average of 67 ± 5 ） who were suspected to have coronary disease, underwent both stress-rest myocardial perfusion imaging （ 185 with exercise stress and 20 with adenosine stress） and coronary angiography （CAG）. All had no percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. Coronary angiography was used as a ＂golden standard＂ to evaluate the sensitivity, specificity and accuracy of the stress-rest myocardial perfusion imaging. χ^2-test was used in data analysis with SPSS 15.0. Results Among 205 patients, there were 57 patients with an abnormal CAG result and 148 patients with a normal result. Of the 57 patients, there were 30 one-, 19 two-, and 8 three-vessel stenosis. Fifteen were mild-, 17 were moderate-, 17 were severe stenosis, and 8 were totally occluded. About 63% （36/57） had positive stress-rest MPI. Of the 148 subjects who had a normal CAG, 135 had negative MPI. The sensitivity, specificity and accuracy of stress MPI were 63% （36/57）, 91% （135/148） and 83% （171/205） in patient level, respectively. The diagnostic sensitivities of stress-rest MPI for detection of one-, two-, and three-vessel stenosis were 57% （ 17/ 30）, 58% （11/19） and 8/8, respectively. All 185 patients who underwent exercise stress MPI were divided into 2 groups according to whether the patients reached the target heart rate or not at the peak of the test. And 53 patients （29%） were group Ⅰ （reached the target heart rate） and 132 patients （71%） were group 2 （did not reach the target heart rate）. The sensitivity of group 1 was higher than tha

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

分 类 号：R686[医药卫生—骨科学]