腺苷负荷心肌灌注显像评价心肌血流供应异常的临床研究  

Evaluation of myocardial blood supply using adenosine stress myocardial perfusion imaging

作　　者：王蒨[1] 杨继敏[1] 米宏志[1] 郭芳[1] 焦建[1] 孟晶晶[1] 丁健[1] 陆遥[1] 

机构地区：[1]首都医科大学附褥北京安贞医院核医学科,100029

出　　处：《中华核医学杂志》2010年第6期363-366,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的 回顾性分析腺苷负荷/静息心肌灌注显像用于评价冠心病心肌血流供应异常的准确性和临床价值.方法 1858例临床确诊或可疑冠心病患者行常规标准程序两日法腺苷负荷/静息99Tcm-甲氧基异丁基异腈心肌灌注断层显像,由2位以上核医学科医师共同阅片定性分析图像.所有患者在显像前后1个月内行冠状动脉（简称冠脉）造影检查.方法间的一致性分析用Kappa检验,Kappa＞0.45为一致性较好.结果 1858例患者中,冠脉造影有1支及1支以上冠脉狭窄≥50%的患者957例,其中单支病变506例,双支病变256例,三支病变195例;共累及冠脉1603支,其中左前降支（LAD）765支、左回旋支（LCX）399支、右冠脉（RCA）439支.腺苷负荷/静息心肌灌注显像示心肌缺血或心肌梗死者1126例,与冠脉造影对照,其诊断冠心病的灵敏度为91.54%（876/957）,特异性为72.25%（651/901）,阳性预测值为77.80%（876/1126）,阴性预测值为88.93%（651/732）,2种方法一致性好（Kappa=0.641）.对LAD、LCX和RCA病变诊断的灵敏度分别为81.31%（622/765）,56.64%（226/399）和70.62%（310/439）;对单支、双支和三支冠脉病变的灵敏度分别为87.55%（443/506）,94.92%（243/256）和97.44%（190/195）.腺苷不良反应的发生率为84.12%（1563/1858）,无严重心脏事件发生.结论 腺苷负荷心肌灌注断层显像诊断冠心病有较高的灵敏度、特异性和准确性,对评价心肌血流供应异常有重要的临床价值.Objective To retrospectively evalute the value and accuracy of adenosine stress and rest SPECT myocardial perfusion imaging. Methods A total of 1858 patients who were suspected or known for coronary artery disease （CAD） underwent 99Tcm-methoxyisobutylisonitrile （ MIBI ） myocardial perfusionSPECT with adenosine infusion using the standard 2-day protocol. Images were interpreted by two or more experienced nuclear medicine physicians . Coronary angiography was carried out in all patients within one month. Kappa test was used to analyze the correlation between the two imaging studies. Results By coronary angiography, there were 957 patients diagnosed of CAD （one-, two-, three-vessel disease： 506,256,195, respectively） and 901 normal. Stenosis was found in 1603 vessels, including left anterior descending coronary artery （LAD）： 765, left circumflex coronary artery （LCX）： 399 and right coronary artery （RCA）： 439. By adenosine induced stress myocardial perfusion imaging, 876 patients were diagnosed of myocardial ischemia （ sensitivity： 876/957, 91.54% ） and 651 patients had negative findings （ specificity：651/901,72.25 % ）. The positive and negative predictive values were 77.80% （ 876/1126 ） and 88.93% （651/732）, respectively. The correlation coefficient between the two imaging studies was 0.641. The vessel-based sensitivity was 81.31% （622/765） for LAD, 56.64% （226/399） for LCX and 70.62% （310/439） for RCA, respectively. The sensitivity for detection of one-, two-, three-vessel stenosis was 87.55% （443/506）, 94.92% （243/256） and 97.44% （190/195）, respectively. The side-effects was mild and transient with an incidence rate of 84.12% （ 1563/1858）, without major cardiac events. Conclusion Stress myocardial perfusion imaging induced by adenosine is reliable for the evaluation of myocardial blood supply in CAD patients.

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

分 类 号：R686[医药卫生—骨科学]