特发性肺动脉高压^18F—FDG右室心肌SPECT显像研究  

^18F-FDG SPECT myocardial imaging of right ventricle in patients with idiopathic pulmonary hypertension

作　　者：何嘉[1] 方纬[1] 何建国[2] 何作祥[1] 熊长明 倪新海[2] 柳志红[2] 顾晴[2] 赵智慧[2] 

机构地区：[1]北京协和医学院、中国医学科学院阜外心血管病医院核医学科,100037 [2]北京协和医学院、中国医学科学院肺血管病诊治中心,100037

出　　处：《中华核医学杂志》2011年第6期400-404,共5页Chinese Journal of Nuclear Medicine

基　　金：国家科技支撑计划课题（2006BAI01A07）;首都医学发展科研基金（2009-1003）

摘　　要：目的探讨^18F—FDG心肌代谢SPECT显像在评价特发性肺动脉高压（IPAH）血流动力学变化、药物疗效和预后等方面的应用价值。方法24例IPAH患者接受^18F-FDG心肌代谢SPECT显像，利用勾画ROI的方法得到右室与左室游离壁的^18F—FDG摄取比值（RV／LV-FOG）。所有患者在核素显像后3d内行右心导管检查，测得平均肺动脉压（mPAP）及肺血管阻力（PVR）；其中15例患者在药物治疗6个月后复查^18F-FDG心肌代谢SPECT显像，并在显像后3d内行第2次右心导管检查；17例患者应用化学发光免疫分析法及酶免疫分析法分别测得血浆氨基末端脑钠肽前体（NT-proBNP）与内皮素-1（ET-1）的含量。所有患者均进行不少于12个月的随访。采用线性回归法分析RV／LV-FDG与mPAP以及Rv／LV—FDG与PVR的相关性。采用Student’s t检验比较治疗前后RV／LV-FDG的变化。应用Log—rank检验分析RV／LV—FDG≥1．15与RV／LV—FDG〈1．15的患者的生存时间均数差异。结果24例患者RV／LV—FDG与mPAP（r=0．562，P〈0．01）、RV／LV-FDG与PVR（r=0．574，P〈0．01）均呈直线相关。RV／LV—FDG与血浆NT—proBNP无显著相关性（r=0．181，P〉0．05），但与ET-1呈直线相关（r=0．669，P〈0．01）。药物治疗有效的6例患者RV／LV-FDG从治疗前的1．38±0．52降至0．92±0．26（t=4．018，P〈0．05）；而治疗无效的9例患者，RV／LV-FDG治疗前后差异均无统计学意义（t=1．861，P〉0．05）。24例患者平均随访时间（21±8）个月，RV／LV—FDG≥1．15患者的生存时间均数为28个月（95％可信区间24～32个月），明显低于RV／LV-FDG〈1．15的患者的生存时间均数34个月（95％可信区间33～35；χ^2=3．956，P〈0．05）。结论应用^18F-FDG心肌SPECT代谢显像检测右室心肌的葡萄糖代谢水平能够反映IPAH血流动力学改变的严重程度，同时对于药物疗效判断以及预后评估具有重要意义。Objective To investigate the value of lSF-FDG SPECT myocardial imaging in evaluating haemodynamic change, treatment outcome and prognosis for idiopathic pulmonary arterial hypertension （IPAH）. Methods AU 24 patients with IPAH underwent is F-FDG SPECT myocardial imaging. Right ventricle/left ventricle （RV/LV）-FDG uptake was calculated by ROI method drawing over the central areas of left and right ventricular free walls. All patients underwent right heart catheterization within 3 days after imaging studies. Mean pulmonary artery pressure （mPAP） and pulmonary vascular resistance （PVR） were recorded. After six month pharmaceutical treatment, 15 IPAH patients were re-examined with 1SF-FDG SPECT myocardial imaging followed by repeated right heart catheterization within 3 days. Plasma N-terminal pro-brain naturetic peptide （NT-proBNP） and endothelin-1 （ ET-1 ） were measured in 17 patients using electrochemiluminescent immunoassay and enzyme immunoassay respectively. All patients were followed up for 12 months at least. Correlations between RV/LV-FDG uptake and mPAP and PVR were determined by simple linear regression analysis. Change of RV/LV-FDG before and after treatment was calculated using Student＇s t-test. Survival in groups with RV/LV FDG uptake ≥ 1.15 and RV/LV-FDG uptake 〈 1.15 were compared using Log-rank test. Results Significant correlations were found between RV/LV-FDG uptake and mPAP （r = 0. 562, P 〈 0.01 ）, and between RV/LV-FDG uptake and PVR （ r = 0. 574, P 〈 0.01 ）. There were no significant correlation between RV/LV-FDG uptake and NT-proBNP（ r = 0. 181 ,P 〉 0.05 ）, but a significant correlation between RV/LV-FDG and ET-1 was observed （r = 0. 669 ,P 〈 0. 01 ）. The RV/ LV-FDG uptake in patients with positive treatment outcome （ n = 6） decreased from 1.38 ± 0.52 to 0. 92±0.26 （ t = 4.018, P 〈 0.05 ） after 6 months treatment. In contrast, no significant change of RV/LV-FDG uptake was seen in those patients （ n = 9 ） with negative treatmen

关 键 词：高血压 肺性 心肌 体层摄影术 发射型计算机 单光子 脱氧葡萄糖 

分 类 号：R730.44[医药卫生—肿瘤]