硝酸甘油介入核素心肌灌注显像评价原发性高血压患者心肌微血管损伤的研究  

Evaluation of ^(99)Tc^m-MIBI myocardial perfusion imaging in patients of essential hypertension with microvascular damage heated with NTG intervention

作　　者：任少阳[1] 周青[1] 侯先存[1] 李智勇[1] 朱辉[1] 夏勇[1] 张延斌[1] 李东野[1] 

机构地区：[1]徐州医学院附属医院,江苏徐州221002

出　　处：《中国临床医学影像杂志》2010年第10期689-692,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:描述原发性高血压病患者心肌微血管损伤在心肌灌注断层显像(MPI)中的影像特征,探讨影像特征与高血压严重程度的关系。方法:应用99Tcm-甲氧基异丁基乙腈(MIBI)MPI定性与半定量计分法,描述102例原发性高血压患者静息MPI(R-MPI)结果与硝酸甘油(NTG)介入MPI(NTG-MPI)特点。结果:①冠状动脉造影(CAG)正常组反向再分布68个节段,占NTG-MPI异常节段数的11.5%;CAG异常组反向再分布170个节段,占NTG-MPI异常节段数的28.8%;两组相比χ2=10.53,P<0.001。②Ⅰ级高血压患者R-MPI和NTG-MPI结果无明显差异(t=1.81,P>0.05);Ⅱ、Ⅲ级高血压患者NTG-MPI心肌缺血节段与R-MPI相比,有显著性差异(t=8.23、7.55,P<0.001)。③随着高血压病情的加重,SRS、SSS、SDS分别从(2.83±1.25)分、(5.67±2.29)分、(-4.35±2.11)分上升到(15.32±6.54)分、(24.19±7.36)分、(-14.62±3.82)分;各项指标三组相比F值分别为25.77、27.69、26.34,P<0.05、0.01、0.01;而且,每个级别高血压同组的SSS与SRS之间也具有非常显著性差异,t=4.35、7.78、6.17,P<0.001。结论:①NTG-MPI中心肌缺血节段的数量和严重程度在一定程度上能够反映高血压患者冠状循环微血管损伤程度;②反向再分布是冠状循环微血管损伤在MPI中的特征性影像表现。Objective：To describe the radionuclide myocardial perfusion imaging（MPI） features of myocardial microvascular damage in the patients with essential hypertension and discuss the relationship between image characteristics and the severity of hypertension.Method：The 99Tcm-MIBI MPI features of resting imaging and nitroglycerin（NTG） intervention was described in 102 patients with essential hypertension by the method of qualitative and semi-quantitative scoring.Result：①After NTG intervention,68 and 170 MPI segments were reversed redistributed separately in CAG normal group and in CAG abnormal group.They accounted for 11.5% and 28.8% separately of all abnormal segments.The ratio of reverse redistribution had significant difference between the two groups（χ2=10.53,P0.001）.②The MPI features in resting state had no significant difference with the image after NTG intervention in the patients with hypertension grade Ⅰ（t=1.81,P0.05）,but the MPI features of the resting state had significant difference with the image after NTG intervention in the patients with hypertension grade Ⅱ（t=8.23,P0.001） and grade Ⅲ（t=7.55,P0.001）.③ The average scores of SRS,SSS and SDS were increased separately from 2.83±1.25,5.67±2.29 and-4.35±2.11 to 15.32±6.54,24.19±7.36 and-14.62±3.82 with aggravation of high blood pressure.The average scores of SRS,SSS and SDS had significant difference among the three groups（F=25.77,P0.05;F=27.69,P 0.01;F=26.34,P0.01）.The scores had significant difference between SSS and SRS in each hypertension group（t=4.35,P 0.001;t=7.78,P0.001;t=6.17,P0.001）.Conclusion：①The segmental number and severity of myocardial ischemic in 99TcmMIBI MPI can reflect the extent of coronary microvascular injury in the patients with essential hypertension.②Reverse redistribution is the characteristic 99Tcm-MIBI MPI feature in the patients with myocardial microvascular damage after NTG intervention.

关 键 词：高血压 硝酸甘油 放射性核素显像 

分 类 号：R544.1[医药卫生—心血管疾病] R817.4[医药卫生—内科学]