腺苷负荷^(99)Tc^m-MIBI门控心肌灌注显像在评价糖尿病无症状心肌缺血中的应用  

Application of adenosine stress ^(99)Tc^m-MIBI gated myocardial perfusion imaging in evaluation of asymptomatic myocardial ischemia for patients with diabetes mellitus

作　　者：董华[1] 张遵城[1] 董萍[1] 张悦[1] 郭永涛[1] 刘晨[1] 

机构地区：[1]天津医科大学第二医院核医学科,天津300211

出　　处：《天津医科大学学报》2011年第2期267-269,274,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨腺苷负荷门控核素心肌灌注显像在评价糖尿病无症状心肌缺血中的临床价值。方法:Ⅱ型糖尿病患者46例,男25例,女21例,平均年龄(54.2±9.6)岁,吸烟18例;健康对照组40例,男23例,女17例,平均年龄(56.4±10.2)岁,吸烟17例。所有患者在入组后抽取清晨空腹血检测血糖、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),并计算体质指数(BMI),对两组临床资料进行比较。两日法先后进行腺苷负荷、静息99Tcm-甲氧基异丁基异腈(MIBI)门控心肌灌注显像,应用定性和半定量计分法对比分析两种状态下的心肌血流灌注及心功能参数,包括总差值(SDS)和左室射血分数(LVEF)。结果:两组患者年龄、性别比、吸烟史及BMI等临床特点比较差异均无统计学意义(P>0.05)。糖尿病组TC、TG、LDL-C、SDS较对照组明显增高,HDL-C和LVEF较对照组明显降低,差异有统计学意义(P<0.05)。糖尿病组负荷状态下有37例(78.3%)共计79个节段出现心肌血流灌注异常,其中可逆性缺损占41个节段,部分可逆性缺损占33个节段,固定缺损5个节段;对照组40例中有5例共计7个节段存在血流灌注异常,均为可逆性缺损,两组比较差异显著(P<0.05)。结论:糖尿病患者存在明显血脂代谢紊乱,心肌血流灌注和心功能也减低,通过核素心肌灌注显像及时检出糖尿病患者中无症状心肌缺血和冠状动脉储备功能减低患者,积极采取相应对策,对于延缓冠心病及其并发症的发生发展是非常必要的。Objective： To evaluate the value of adenosine stress 99Tcm-methoxyisobutyhsonitrile（MIBI） gated myocardial perfusion imaging（G-MPI） for the detection of asymptomatic myocardial ischemia in patients with diabetes mellitus.Methods： Forty-six patients with type 2 diabetes mellitus（25 males,21 females）and forty healthy subjects（23 males,17 females）were collected.The clinical characteristics,such as blood glucose,cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）and body mass index（BMI）were detected.In each case,the adenosine stress and rest 99Tcm-MIBI G-MPI were underwent in two days,respectively.The results of myocardial perfusion imaging and heart functional parameters were compared between two groups by Qualitative and semi-quantitative analysis,which include sum difference score（SDS）and left ventricular ejection fraction（LVEF）.Results： No significance was observed at age,sex,smoking and BMI between the two groups（P0.05）.Compared with the control group,the level of TC,TG,LDL-C and SDS were higher and the level of HDL-C and LVEF were lower In the diabetes mellitus group（P0.05）.The positive rate of stress G-MPI in DM group was obviously higher than that in control group,which was 78.3%（37/46） VS 12.5%（5/40）,respectively.Most defects of MPI in the diabetes mellitus group were reversible（41/79）and partial reversible defects（33/79）,5 were nonreversible defects.Whereas,all defects of MPI in control group were reversible（7/7）.Conclusion： Patients with diabetes mellitus are always exposed to abnormal lipoprotein metabolism,reduction of myocardial perfusion and heart function.MPI are the key point for evaluation of asymptomatic myocardial ischemia and coronary reservoir in patients with DM,which plays an important role in taking appropriate measures to prevent coronary artery disease and relative companies.

关 键 词：腺苷 99TCM-MIBI 心肌灌注显像 糖尿病 

分 类 号：R445[医药卫生—影像医学与核医学]