冠状动脉痉挛致心肌血流灌注降低：反向再分布的机制研究  

Reverse 201Tl myocardial redistribution induced by coronary artery spasm

作　　者：向定成[1] 尹吉林[2] 龚志华[1] 谢振宏[1] 张金赫[2] 文花飞[1] 易绍东[1] 

机构地区：[1]广州军区广州总医院心血管内科,510010 [2]广州军区广州总医院核医学科,510010

出　　处：《中华核医学杂志》2010年第5期300-303,共4页Chinese Journal of Nuclear Medicine

基　　金：基金项目：广东省自然科学基金重点项目（9251001002000002）

摘　　要：目的 探讨冠状动脉痉挛患者核素心肌灌注显像反向再分布（RR）的机制.方法 选择双嘧达莫负荷201TI心肌灌注显像表现为RR且诊断为冠状动脉痉挛的患者26例（RR组）、无冠状动脉狭窄及RR者16例（对照组）,在冠状动脉造影术中重复双嘧达莫试验,测量并比较注射双嘧达莫前后RR相关、非RR相关血管和对照组相应血管的校正心肌梗死溶栓疗法（TIMI）血流帧计数（CTFC）和心肌血流灌注积分（TMPG）.统计学处理采用t检验、χ2检验及相关分析.结果 冠状动脉造影见RR相关血管僵硬,血流速度和心肌灌注明显低于非RR相关血管,且RR区域静态心肌灌注缺损与冠状动脉造影血流速度缓慢高度相关（r=0.79,t=10.18,P＜0.001） 而对照组的各支冠状动脉血流速度和心肌灌注无明显差异.RR相关血管注射双嘧达莫前后CTFC分别为（36±6）帧及（26±7）帧（t=4.15,P＜0.01） TMPG分别为（2.02±0.39）级和（2.92±0.12）级（t=2.25,P＜0.05） 非RR相关血管注射前后CTFC分别为（29±7）帧及（25±5）帧（t=2.31,P＜0.05） TMPG分别为（2.56±0.31）级和（2.96±0.06）级（t=2.17,P＜0.05） 而对照组注射双嘧达莫前后TCFC及TMPG均无明显变化（t=0.932及0.867,P均＞0.05）.结论 冠状动脉痉挛患者静息状态下RR相关血管及微血管处于轻度痉挛状态,导致血流速度及心肌灌注缓慢 而负荷状态下血管扩张,使血流速度和心肌灌注加快,因而呈现RR.Objective To investigate the mechanism of reverse redistribution （RR） on dipyridamole 201Tl myocardial perfusion studies in the patients with coronary artery spasm. Methods Twenty-six patients with coronary artery spasm and presented as RR on dipyridamole 201Tl myocardial perfusion studies were enlisted as RR group, while other 16 patients with no coronary artery stenosis nor RR were enlisted as control group. Dipyridamole test was repeated during coronary angiography. Corrected thrombolysis in myocardial infarction （TIMI） frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） were measured at RR related and non-RR related coronary arteries before and after dipyridamole infusion respectively.All of the data were analyzed by Student＇s t-test orχ2-test and correlation analysis. Results Coronary artery angiography showed slower blood flow and lower myocardial perfusion in RR related vessels when compared with non-RR related vessels in RR group, but there was no significant difference among the main coronary arteries in control group. The perfusion defects of RR area at rest were positively related to slowerblood velocity at corresponding coronary arteries （ r = 0.79, t = 10.18, P 〈 0.001 ）. In RR related vessels,CTFC were （36 ±6） frames and （26 ±7） frames （t =4.15, P 〈0.01 ）, while TMPG were （2.02 ±0.39）grades and （2.92 ± 0.12） grades （ t = 2.25, P 〈 0.05 ） before and after dipyridamole infusion, respectively.In non-RR related vessels, CTFC were （29 ±7） frames and （25 ±5） frames （t =2.31, P 〈0.05）, while TMPG were （2.56 ± 0.31 ） grades and （2.96 ± 0.06） grades （ t = 2.17, P 〈 0.05 ） before and after dipyridamole infusion, respectively. However, there were no significant changes of CTFC and TMPG before and after dipyridamole infusion in control group （ t = 0.932, 0.867, respectively, both P 〉 0.05 ）. Conclusion RR is related to the decreased blood flow and myocardial perfusion induced by coronary artery spasm at rest

关 键 词：冠状血管痉挛 放射性核素显像 铊放射性同位素 双嘧达莫 

分 类 号：R686[医药卫生—骨科学]