心肌桥患者乙酰胆碱试验与~99Tc^m-甲氧基异丁基异腈左心室心肌灌注显像的评价  

Evaluation on acetylcholine test and myocardial perfusion 99Tc m-methoxy isobutyl isonitrile imaging in patients with myocardial bridge

作　　者：叶新和[1] 杨承健[1] 徐欣[1] 曹佳宁[1] 董丰[1] 王仁荣[1] 胡大一[2] 

机构地区：[1]南京医科大学附属无锡第二医院心内科,江苏无锡214002 [2]北京大学人民医院心脏中心

出　　处：《中华高血压杂志》2014年第1期69-73,共5页Chinese Journal of Hypertension

摘　　要：目的探讨心肌桥患者乙酰胆碱试验与静息-负荷99 Tcm-甲氧基异丁基异腈(MIBI)左心室心肌灌注显像特点及临床意义。方法 2009-01-2011-12入选43例先后进行冠状动脉造影证实的心肌桥患者,并进行乙酰胆碱试验;观察心肌桥患者99 Tcm-MIBI静息及负荷心肌血流灌注显像分布特点。结果 43例患者中,位于前降支心肌桥占86.0%(37/43),收缩期狭窄NobelⅡ级、Ⅲ级分别占55.8%(24/43)和30.2%(13/43)。心肌桥合并冠状动脉痉挛29例(67.4%),乙酰胆碱试验阳性占81.4%(35/43)。43例心肌桥患者中出现异常心肌灌注显像37例(86.0%)。其中29例患者左心室心肌出现2处不同部位的放射性分布改变。6例收缩期狭窄NobelⅠ级心肌灌注正常;24例收缩期狭窄NobelⅡ级出现异常心肌灌注显像,17例表现为中度、重度心肌灌注减少,6例表现为轻度心肌灌注减少,1例表现为反向再分布;13例收缩期狭窄NobelⅢ级出现异常心肌灌注显像,10例表现为中度、重度心肌灌注减少,1例表现为轻度心肌灌注减少,2例表现为反向再分布。结论心肌桥患者心肌桥严重程度与心肌缺血有关,乙酰胆碱可诱发壁冠状动脉痉挛,核素心肌灌注显像心肌桥NobelⅡ、Ⅲ级患者均出现心肌血流灌注异常。Objective To investigate the characteristics and clinical significance of acetylcholine test and resting- stress 99 Tcm_methoxy isobutyl isonitrile （MIBI） of left ventricular myocardial perfusion imaging in patients with my- ocardial bridge. Methods From January 2009 to December 2011, forty-three consecutive patients diagnosed as my- ocardial bridge by coronary angiogram were recruited to perform acetylcholine test. The angiographic characteris- tics were indicated by resting-stress 99Tcm_MIBI myocardial perfusion imaging. Results Among these 43 patients with myocardial bridge, the left anterior descending artery affected occupied 86.0 % （37/43） , and the systolic steno- sis incidences of Noble grade Ⅱ and grade Ⅲ were 55.8% （24/43） and 30.2% （13/43） respectively. Twenty-nine cases suffered from myocardial bridge and coronary artery spasm （ 67.4% ）, and thirty-five cases were positive in acetylcholine tests （81.4%）. Among the forty three patients, thirty-seven cases with myocardial bridge depicted abnormal myocardial perfusion, and twenty-nine cases displayed radioactivity distribution changes in two different re- gions of left ventricular myocardium. At the level of Noble grade I systolic stenosis, six cases indicated normal myocardial perfusion. Twenty-four patients with Noble grade Ⅱ systolic stenosis manifested abnormal myocardial perfusion, of which seventeen cases were mediate and severe myocardial perfusion defect, six subjects were mild per- fusion defectj and one patient was charactered with reverse redistribution. Additionally, among the thirteen pa- tients with grade Ⅲ systolic stenosis,ten cases showed mediate and severe myocardial perfusion defect, one was mild myocardial perfusion defect, and two showed reverse redistributions. Conclusions The severity of myocardial bridge in patients is related to myocardial ischemia. Acetylcholine can evoke spasm of coronary artery in myocardial bridge wall. The radionuclide myocardial perfusion imaging of patients with Noble grade

关 键 词：心肌桥 冠状动脉造影 乙酰胆碱 99Tcm-甲氧基异丁基异腈 心肌缺血 

分 类 号：R541.1[医药卫生—心血管疾病]