腺苷负荷心肌灌注显像评价中年女性心肌供血异常的临床价值  

The diagnostic value of adenosine stress test myocardial perfusion imaging for middle-aged female patients

作　　者：米宏志[1] 王蒨[1] 焦建[1] 孟晶晶[1] 丁健[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所核医学科,北京100029

出　　处：《心肺血管病杂志》2012年第4期455-457,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生局首都医学发展基金(编号20073089);首都医科大学附属北京安贞医院院长科技发展基金(编号2010C01)

摘　　要：目的:评价国产腺苷负荷99Tcm-MIBI心肌灌注显像对65岁以下的中年女性患者心肌供血异常的判断临床价值。方法:2007年1月至2008年7月临床怀疑冠心病的中年女性109例,年龄40～65岁,平均年龄(54.9±6.1)岁,所有患者均在1个月内施行常规2d法腺苷负荷-静息心肌灌注显像(MPI)和冠状动脉造影术(CAG)检查。MPI和CAG图像由2名以上核医学/放射科医师共同读片;MPI评价标准:供血区某一心肌节段负荷时,出现放射性稀疏或缺损,静息时消失或改善,判定为心肌缺血;如静息时仍为放射性缺损,判定为心肌梗死。CAG评价标准:3支主要冠状动脉血管中至少有1支主要冠状动脉管径狭窄≥50%,判定为阳性。MPI与CAG对照,评价腺苷MPI对冠心病的诊断效能(敏感性、特异性和准确性)。结果:109例受检者中,MPI显示:阴性62例,阳性47例,心肌缺血42例,心肌梗死5例;累及59个室壁段,其中前降支供血区32段,回旋支供血区12段,右冠状动脉供血区15段。CAG显示:冠状动脉正常72例,冠状动脉异常37例,其中单支病变23例,双支病变7例,3支病变7例;冠状动脉异常37例中核素心肌灌注显像阳性31例,阴性6例;冠状动脉正常72例中核素心肌灌注显像56例阴性,16例阳性。腺苷负荷MPI对65岁以下女性患者诊断冠心病的灵敏度为83.8%(31/37例),特异性为77.8%(56/72例),准确性为79.8%(87/109例),阳性预测值为65.9%(31/47例),阴性预测值为90.3%(56/62例)。结论:腺苷负荷心肌灌注显像用于中年女性冠心病的诊断有较高的诊断效能,具有较高的临床应用价值。可作为中年女性早期诊断冠心病在运动心电图之外有效的、优先考虑的选择。Objective：Evaluating the clinical value of adenosine stress test myocardial perfusion ima- ging （MPI） by 99Tcm-MIBI for middle-aged female. Methods： Analyzing 109 suspected CAD middle-aged fe- male patients from Jan. 2007 to Jul. 2008, age from 40 to 65 [ average age is （54. 9±6. 1 ） years old], and all patients underwent two days adenosine stress/rest MPI and coronary angiography （CAG） in one month. The images of MPI and CAG were evaluated by more than 2 nuclear medicine physicians and radiologists. The MP- Ievaluation criterion is ： myocardial ischemia is diagnosed if there is decrease or defect of radioactivity at stress test in some myocardial segment with improvement of radioactivity at rest; and myocardial infarction is diag- nosed if it is still defect of radioactivity combined with stress. CAG evaluation criterion is： it is judged positive if stenosis equal or larger than 50% in one of three main coronary arteries at least. Statistics analyses were per-formed by mean ＋ standard deviation. Diagnostic efficacy is evaluated for CAD by MPI compared with CAG （sensitivity, specificity and accuracy）. Results：In all 109 patients, MPI showed： 62 negtive, 47 positive, 42 myocardial ischemia and 5 myocardial infarction; involving 59 segments including LAD 32, LCX 12 and RCA 15. CAG showed： 72 normal coronary arteries with 56 negative MPI and 16 positive MPI; 37 abnormal ones in- cluding 23 one-vessel stenosis, 7 two-vessel stenosis and 7 three-vessel stenosis,with 31 positive MPI,6 nega- tive MPI; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of aden- osine stress MPI for female patients to diagnosing CAD is 83.78% （31/37 ）, 77. 78% （56/72） ,79. 82% （87/ 109） ,65.90% （ 31/47 ）, 90. 32% （ 56/62 ） individually. Conclusion： There is higher clinical value and diag- nostic efficacy of adenosine stress test MPI for diagnosing CAD with middle-aged female patients. And it can be a good choice for diagnosing early CAG wit

关 键 词：冠状动脉疾病 发射型计算机断层 腺苷 心肌灌注显像 

分 类 号：R54[医药卫生—心血管疾病]