门控心肌断层显像左室短暂性缺血扩张的影响因素  

Factors of Transient Ischemic Dilation on Gated Myocardial Perfusion Imaging

作　　者：李眉[1] 戴皓洁[1] 

机构地区：[1]首都医科大学附属同仁医院核医学科,北京100730

出　　处：《标记免疫分析与临床》2010年第3期160-165,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：门控心肌断层显像中左室短暂性缺血扩张被认为是严重冠心病(CAD)的标志。目前对影响左室短暂性缺血扩张的因素还不确定。本研究的目的是观察能影响左室短暂缺血扩张的临床因素,特别是可独立影响心内膜下血流灌注的因素,如左室肥大(LVH)和糖尿病(DM)。对87名行负荷门控心肌断层显像、冠状动脉造影及超声心动图的患者,采用QG-SPECT软件自动对短暂性缺血扩张进行定量分析。左心室短暂性缺血扩张率(TID率)的cutoff值≥1.22代表短暂缺血扩张。采用标准20段、5点打分系统定量缺血心肌(缺血分数SDS)。LVH定义为M-型超声的左室壁厚度>11mm。严重CAD定义为左前降支或者右冠及回旋支动脉严重狭窄(≥90%)。87名患者中,13名有左室短暂性缺血扩张,这13名中9名有LVH,11名有糖尿病(DM),10名有严重CAD。严重CAD、DM及LVH是短暂性缺血扩张的独立预测因素。LVH及DM增加了严重CAD发生短暂性缺血扩张的几率。在严重CAD,短暂性缺血扩张的发生率,由无LVH的10%增加到有LVH的55%(P<0.01)。同时,由无DM的4%增加到有DM的86%(P<0.01)。门控心肌断层显像中左室短暂性缺血扩张与严重CAD密切相关,但LVH和DM的存在改变了严重CAD发生左室短暂性缺血扩张的灵敏性和特异性。That transient ischemic dilation（TID） of the left ventricle on SPECT myocardial perfusion imaging（MPI） is the marker of severe and extensive coronary artery disease（CAD）.But other clinic factors influencing TID is less certain.The object of this study was to investigate that of the factors,as left ventricle hypertrophy（LVH） and diabetes（DM）.MPI 87 patients who undertaken coronary angiography and transthoracic echocardiography within 1 month of stress electrocardiography-gated MPI were retrospectively analyzed.TID was assessed quantitatively using a soft program.A ratio cutoff of ≥1.22 was to represent TID.Summed stress score and summed different score（ischemia score） were determined using 20-segment 5-point scoring system to quantify myocardial ischemia.LVH was defined as a left ventricular wall thickness of 11mm on M-mode echocardiography.Severe CAD was defined as severe stenosis（≥90%） of either the left anterior descending artery or both the right coronary and lateral circumflex arteries.All of the 87 patients,13 of them had TID,9 of them TID had LVH,and 10 of the TID had severe CAD.A high percentage had DM（84%）.Severe CAD,diabetes and LVH were independent predictors of TID,the effect of LVH on the incidence of TID was additive increasing the incidence from without LVH 10% to with LVH 55%（P0.01）.Likewise,with severe CAD,the incidence of TID rose from in patient without diabetes 4% to in those with diabetes 86%（P0.01）.Transient ischemic dilation of the left ventricle on Gated SPECT myocardial perfusion imaging is associated with the severe CAD,but this association is modified by LVH and DM.

关 键 词：心肌灌注显像 短暂性缺血扩张 左室肥大 冠状动脉疾病 糖尿病 

分 类 号：R540.4[医药卫生—心血管疾病]