双核素心肌灌注-代谢显像评价存活心肌对心肌梗死患者择期血运重建术后左心功能的影响  

The effect of viable myocardium on left ventricular function after elective revascularization in patients with myocardial infarction by dual-isotope simultaneous acquisition myocardial perfusion-met- abolic imaging

作　　者：任少阳[1] 侯先存[1] 周青[1] 李智勇[1] 朱辉[1] 夏勇[2] 张延斌[2] 李东野[2] 

机构地区：[1]徐州医学院附属医院核医学科,221002 [2]徐州医学院附属医院心内科,221002

出　　处：《中华核医学杂志》2011年第3期169-173,共5页Chinese Journal of Nuclear Medicine

摘　　要：目的采用^99Tc^m-MIBI加^18F-FDG双核素心肌灌注-代谢显像（DISA）评价冠心病心肌梗死患者有无存活心肌，以判断择期血运重建后存活心肌对左心功能的影响。方法选择确诊心肌梗死患者91例，行DISA。根据超声心动图（UCG）结果将患者分为心功能不全（A组）和心功能正常（B组）2组，在行PCI术后1，3和6个月观察UCG结果。采用SPSS13．0软件进行统计学处理，2组间均值比较采用t检验，率的比较采用，检验。结果A组灌注平均缺损（9．8±3．5）个节段，B组灌注平均缺损（5．4±2．6）个节段；2组相比，t=6．87，P〈0．01。A组代谢平均缺损（7．5±3．4）个节段，B组代谢平均缺损（4．6±2．8）个节段，2组相比，t=4．46，P〈0．01。A组检出存活心肌173个节段，占37．8％（173／458），B组检出188个节段，占61．2％（188／307），2组相比，x2=40．61，P〈0．001。A组灌注显像总评分（SPS）为（Z8．43±11．86）分，代谢显像总评分（SMS）为（20.17±8．52）分，（代谢-灌注）总评分之差（SDS）为（0．39±3．17）分；B组SPS为（21．36±9．54）分，SMS为（15．19±5．74）分，SDS为（-12．72±4．55）分，2组相比，t=3．15，3．32和15．59，P均〈0．01。A组存活心肌≥4个节段的LVEF升高差值（ALVEF）为（12．81±2．62）％，明显高于B组的（5．90±1．91）％，t=16．33，P〈0．001；左心室舒张末期内径回缩差值（△LVEDd）为（-13．13±4．20）mm，也明显高于B组（-7．75±2．31）mm，t=6．86，P〈0．001；A组存活心肌〈4个节段的△LVEF和△LVEDd则明显低于B组，t=3．25和4．92，P均〈0．01。结论心肌梗死区是否有存活心肌及存活心肌节段数可能是择期血运重建后左心功能改善程度的重要影响因素。Objective To evaluate the effect of myocardial viability on left ventricular function after elective revascularization in patients with myocardial infarction by ^99Tc^m-MIBI and ^18F-FDG dual-isotope simultaneous acquisition （DISA） myocardial perfusion-metabolic imaging. Methods Ninety-one patients clinically confirmed of myocardial infarction underwent DISA imaging. Based on the results of echocardiography, the patients were divided into heart failure group （group A ） and normal cardiac function group （group B）. After PCI, left ventricular function was measured by echocardiography in 1, 3 and 6 months. The t-test and x2-test were used to compare the difference between the two groups using SPSS 13.0. Results The average number of diseased segments by myocardial perfusion imaging was 9.8 ± 3.5 and 5.4 ± 2.6 in groups A and B, respectively （t = 6.87, P 〈0.01 ）. The average number of diseased segments by myocar- dial metabolic imaging was 7.5 ± 3.4 and 4.6 ± 2.8 in groups A and B, respectively （ t = 4.46, P 〈 0. 01 ）. There were 173 segments with viable myocardium （ 173/458 ： 37.8% ） in group A and 188 segments with viable myocardium （ 188/307 ： 61.2% ） in group B （X2 = 40.61, P 〈 0. 001 ）. The summed perfusion score （ SPS）, summed metabolism score （SMS） and summed difference score （ SDS = SMS - SPS） were 28.43 ± 11.86 vs 21.36 ± 9.54, 20.17 ± 8.52 vs 15.19 ± 5.74 and 0.39 ± 3.17 vs - 12.72 ± 4.55, respoefively in groups A and B （t=3.15, P〈0.01; t =3.32, P〈0.01; t =15.59, P〈0.01）. The mean change of LVEF （ALVEF） and the mean change of left ventfieular end-diastole dimension （ALVEDd） of the patients with more than 4 viable myocardial segments in group A were significantly more than those in group B（ （12.81 ±2.62）% vs （5.90±1.91）%, t=16.33, P〈0. 001; （ -13.13 ± 4. 20） mm vs （ - 7.75 ± 2.31 ） mm, t = 6.86, P 〈 0. 001 ）. However, the ALVEF and △LVEDd of the patients with less than 4 viable myocardial segments

关 键 词：心肌梗塞 血管成形术 经皮 经腔冠状动脉 心室功能 左 体层摄影术 发射型计算机 单光子 脱氧葡萄糖 MIBI 

分 类 号：R542[医药卫生—心血管疾病]