腺苷负荷^(99m)Tc-MIBI SPECT心肌显像在缺血性心脏病诊断中的价值及安全性评价  

Diagnostic Value and Safety of Adenosine Stress ^(99m)Tc-MIBI SPECT Myocardial Perfusion Imaging for Ischemic Heart Disease

作　　者：王丽娟[1] 王昊[1] 孙英贤[1] 周久贸[2] 李娜[2] 李亚明[2] 

机构地区：[1]中国医科大学附属第一医院心内科,沈阳110001 [2]中国医科大学附属第一医院核医学科,沈阳110001

出　　处：《中国医科大学学报》2011年第6期537-540,共4页Journal of China Medical University

基　　金：辽宁省科技攻关计划课题(2007225004-2);"十一五"国家科技支撑计划课题(2007BA105BO1)

摘　　要：目的评价腺苷负荷99mTc-MIBI单光子发射型计算机断层(SPECT)心肌显像在诊断缺血性心脏病中的价值及安全性。方法对117例临床确诊或疑似的缺血性心脏病患者,静脉泵入腺苷,剂量为140μg.kg-.1min-1,用药时间6 min。于泵入腺苷3 min末,注射核素显像剂99mTc-MIBI 760 MBq,1.5 h后行SPECT心肌显像,若显像异常,当日行静息心肌显像。所有患者行冠状动脉造影(CAG)或CT冠状动脉造影(CTA)检查,腺苷应用过程中观察血压、心率、心电图的变化及其不良反应。结果 82例CAG或冠脉CTA阳性,腺苷负荷99mTc-MIBI SPECT诊断缺血性心脏病的敏感性为92.7%,特异性为80.0%,准确性为88.9%,阳性预测值为91.6%,阴性预测值为82.4%。它对判断冠状动脉分支狭窄具有较高的价值,其中左前降支的敏感性、特异性及准确性分别为90.1%、80.4%和86.3%;左回旋支为77.7%、83.3%和82.1%;右冠状动脉为91.5%,78.6%,83.8%。腺苷的不良反应轻、持续时间短。结论腺苷负荷99mTc-MIBI SPECT对诊断缺血性心脏病、判断冠状动脉分支病变具有较高的价值,临床应用安全性高。Objective The purpose of this study was to evaluate the diagnostic value and safety of adenosine stress 99mTc-MIBI SPECT myocardial perfusion imaging for ischemie heart disease （IHD）. Methods Subjects were 117 patients with diagnosed or suspected IHD. Adenosine was infused intravenously at a rate of 140 μg·kg ^-1·min^-1 for 6 rain. At the end of 3 min after adenosine infusion,760 MBq of 99mTc-MIBI was injected intravenously. Adenosine stress SPECT were performed 90 minutes after injection of 99mTc-MIB1. If the imaging was abnomaal, the resting 99mTc-MIBI SPECT would be obtained at tile same day. All patients underwent coronary angiography （CAG） or coronary CT angiography （CTA） within two weeks. Blood pressure, heart rate, electrocardiogram and side effects were observed in the process of injecting adenosine. Results 82 patients were diagnosed as IHD by CAG or CTA. The sensitivity, specificity, accuracy, positive and negative predictive value of adenosine stress 99mTc-MIBI SPECT for the diagnosis of IHD were 92.7%, 80%, 88.9% ,91.6%, and 82.4% respectively. The sensitivity,specificity and accuraey were 90.1%, 80.4%, 86.3% ;77.7%, 83.3% ,82.1% ;91.5% ,78.6% ,83.8% for the diagnosis of LAD, LCX and RCA stenosis, respectively. Side effects of adenosine were light, and recovered quickly. Conclusion Adenosine stress 99mTc- MIBI SPECT is valuable for diagnosing IHD and evaluating coronary artery branch stenosis, and clinically safe.

关 键 词：99Tc-甲氧基异丁基异腈 单光子发射型计算机断层术 冠状动脉造影 CT冠状动脉造影 缺血性心脏病 安全性 

分 类 号：R541.4[医药卫生—心血管疾病] R817.4[医药卫生—内科学]