^(99)Tc^m-MIBI心肌断层显像用于直接PTCA及静脉溶栓治疗AMI的对比研究  

A comparative study of primary angioplasty with intravenous thrombolysis in the treatment of acute myocardial infarction using ^(99)Tc^m MIBI SPECT imaging

作　　者：王铁[1] 贾三庆[1] 李田昌[1] 陈方[1] 胡大一[1] 崔亮[1] 武秀朵[2] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院核医学科,100020 [2]首都医科大学附属北京红十字朝阳医院心脏中心

出　　处：《中华核医学杂志》1999年第4期204-206,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的　比较直接经皮冠状动脉腔内成形术（ 直接ＰＴＣＡ） 和静脉溶栓疗法在急性心肌梗死（ＡＭＩ） 治疗中的效果。方法　１２４ 例ＡＭＩ患者（ 直接ＰＴＣＡ组６０ 例，溶栓组６４ 例） 均于发病２ 周时和１２ 周后行９９Ｔｃｍ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像，将左室心肌分为２０ 个节段，并对心肌摄取９９ＴｃｍＭＩＢＩ的程度进行打分，分别计算发病２ 周时心肌显像的总积分（Ｓ２ＷＳ） 、发病后１２ 周心肌显像的总积分（Ｓ１２ＷＳ）和两者相减的积分（ＳＤＳ）。直接ＰＴＣＡ组和溶栓组分别有３８ 人和３５ 人于心肌显像后行平衡法门控心室显像。结果　直接ＰＴＣＡ 组与溶栓组比较：Ｓ２ＷＳ为１８－３±６－９ 和２８－６ ±７－３（ｔ＝７－３，Ｐ＜ ０－００１），Ｓ１２ＷＳ为１１－２ ±４－２ 和２４－４ ±６－２（ｔ＝ １１－７，Ｐ＜ ０－００１），ＳＤＳ为７－６ ±３－２ 和４－３ ±１－１（ｔ＝ ５－４，Ｐ＜ ０－００１）。直接ＰＴＣＡ组和溶栓组入院２ 周时的左室射血分数（ＬＶＥＦ） 分别为（４１－４ ±６－５） ％ 和（３９－５ ±７－２）％ （ｔ＝ １－５ ，Ｐ＞ ０－０５），出院１２ 周后的ＬＶＥＦ 分别为（６２－６ ±７－８）％ 和（５１－４Objective To evaluate and compare the therapeutic effectiveness of primary percutaneous transluminal coronary angioplasty (PTCA) with that of intravenous thrombolysis for acute myocardial infarction (AMI) using 99 Tc m MIBI myocardial SPECT imaging Methods A total of 124 patients with AMI was undergoing primary PTCA (PTCA group, 60 patients) or intravenous thrombolysis therapy (thrombolysis group, 64 patients) 99 Tc m MIBI myocardium SPECT imaging was performed 2 weeks and 12 weeks after the onset of AMI Two to three days after scanning, the left ventricular ejection fraction (LVEF) was measured by radionuclide gated cardiac blood pool imaging on 38 patients in PTCA group and 35 patients in thrombolysis group Results The following imaging parameters and LVEF in PTCA and thrombolysis groups were compared in pairs: S2WS (score of scanning after 2 weeks) was 18 3±6 9 vs 28 6±7 3 (t=7 3, P<0 001), S12WS (score of scanning after 12 weeks) was 11 2±4 2 vs 24 4±6 2 (t=11 7, P<0 001), SDS (S2WS S12WS) was 7 6±3 2 vs 4 3±1 1 (t=5 4, P<0 001) LVEF of PTCA group and thrombolysis group at 2 weeks was (41 4±6 5)% and (39 5±7 2)% (t=1 5, P>0 05) After 12 weeks LVEF were (62 6±7 8)% and (51 4±8 8)% (t=7 4, P<0 001) Conclusions 99 Tc m MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the PTCA and intravenous thrombolysis in treatment of AMI At the same time, the results indicate that primary PTCA seems to be more effective than intravenous thrombolysis.

关 键 词：心肌梗死 ^99TC^M-MIBI AMI PTCA 心肌断层显像 

分 类 号：R542.22[医药卫生—心血管疾病] R817.42[医药卫生—内科学]