川崎病亚急性期心肌灌注显像与超声心动图对冠状动脉病变的诊断价值  

Detection of coronary artery damage at sub-acute phase of Kawasaki disease with myocardial perfusion imaging and two-dimensional echocardiography

作　　者：王耀明[1] 曹亚船[1] 万卫星[2] 徐庄剑[1] 郁春景[2] 陈新颜[3] 马亚萍[1] 尤徐阳[2] 黄建伟[1] 

机构地区：[1]无锡市第四人民医院儿科,江苏省无锡市214062 [2]无锡市第四人民医院核医学科,江苏省无锡市214062 [3]无锡市第四人民医院超声心动图室,江苏省无锡市214062

出　　处：《中华核医学与分子影像杂志》2013年第5期351-354,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^99Tc^m-MIBI静息MPI与二维超声心动图（2-DE）对川崎病（KD）患儿亚急性期冠状动脉病变的诊断价值。方法回顾性分析1999年8月至2012年3月间该院收治的24例KD患儿。所有患儿[男14例，女10例，年龄（2．50±2．19）岁]均于亚急性期行静息MPI和2-DE检查，每7天复查1次直至疾病恢复期。计算2种方法对患儿冠状动脉病变的阳性检出率及检出时间，应用SPSS13．0软件对数据行驴检验和Wileoxon秩和检验。结果该组患儿静息MPI阳性者占66．67％（16／24），2-DE阳性者占37．50％（9／24），二者阳性检出率差异有统计学意义（x^2=4．00，P〈0．05）。静息MPI、2-DE阳性检出时间分别为（13．79±2．86）d和（15．89±5．60）d（Z=-0．746，P〉0．05）。2种方法均阳性者占33．33％（8／24），均阴性者占29．17％（7／24）；静息MPI阳性、2-DE阴性者占33．33％（8／24），前者阴性、后者阳性者占4．17％（1／24）。有4例静息MPI缺血区在2-DE上可见相应区域供血冠状动脉存在病变。结论静息MPI是一种较理想的、判断KD亚急性期冠状动脉循环异常及心肌缺血性损害程度和范围的无创检查手段，结合2-DE检查则有利于更全面地发现病变。Objective To compare the diagnostic values of rest 99Tcm-MIBI MPI and two-dimen- sional echoeardiography （2-DE） for the detection of coronary artery damage at sub-acute phase of Kawasaki disease （ KD ）. Methods Twenty-four children （ 14 males and 10 females, mean age ： （ 2.50± 2.19 ） years） with KD at sub-acute phase were studied between August 1999 and March 2012. All patients underwent rest 99Tcm-MIBI MPI and 2-DE.X2 and Wilcoxon rank sum tests with SPSS 13.0 were used for data analysis. Results The positive rate of MPI was 66.67% （ 16/24 ）, significantly higher than that of 2-DE （37. 50%, 9/24; X2= 4.00, P〈0.05）. There was no significant difference between the duration for definite diagnosis by MPI and 2-DE （ （13.79±2.86） vs （15.89±5.60） d; Z=-0.746, P〉0.05）. Eight of 24 patients （33.33%） had positive results for both MPI and 2-DE, and 7 patients （29.17%） had negative find- ings for both methods. Eight patients （8/24, 33.33%） were positive on MPI but negative on 2-DE, and 1 patient （ 1/24, 4.17% ） was positive on 2-DE but negative on MPI. The areas of myocardial ischemia detected by MPI in 4 patients were consistent with the findings by 2-DE. Conclusions Rest 99Tcm-MIBI MPI is a valuable noninvasive method to evaluate the coronary circulation and myocardial ischemia in KD patients at sub-acute phase. In combination with MPI, 2-DE might provide more comprehensive information for the evaluation of KD.

关 键 词：黏膜皮肤淋巴结综合征 冠状动脉疾病 体层摄影术 发射型计算机 单光子 超声心动描记术 MIBI 

分 类 号：R725.4[医药卫生—儿科] R817.4[医药卫生—临床医学] R445.1