如何正确评价等长运动核素心血池显像诊断冠心病的临床价值  

How to accurately assess the clinical value of isometic exercise radionuclide ventriculography in diagnosis of coronarry artery disease

作　　者：杨顺方[1] 诸惠萍[1] 曾骏[1] 谢文辉[1] 俞志昌[1] 

机构地区：[1]上海市胸科医院,上海200030

出　　处：《核技术》2001年第5期408-412,共5页Nuclear Techniques

摘　　要：通过核素心血池显像测定静息和等长运动冠心病患者左室功能指标的变化 ,探讨等长运动核素心血池显像对冠心病诊断的临床价值。 8例正常人、38例冠心病患者静息状态下核素心血池显像后 ,双手握力 5— 10min并同时进行采集从而获得静息和运动状态下两组心功能指标 ,并且行冠状动脉及左室造影。统计方法用t检验和四格表等效检验。结果表明 ,左室射血分数(LVEF)、高峰充盈率 (PFR)、左室舒张末期容积 (EDV)、左室收缩末期容积 (ESV)和心率 (HR)在静息状态下 ,对照组和冠心病一、二、三支冠脉病变组分别为 ( 57± 10 .4 5) %、( 53.67± 5.0 ) %、( 52 .4 7± 8.2 6) %、( 52 .81± 8.89) % ,p =NS ;2 .94± 0 .4 4、2 .87± 0 .2 9、2 .71± 0 .88、3.0 7± 0 .71(EDV s) ,p=NS ;1.38± 0 .15、1.36± 0 .0 5、1.34± 0 .0 6、1.34± 0 .0 6,p =NS ;0 .59± 0 .11、0 .62± 0 .0 6、0 .66± 0 .0 6、0 .65± 0 .1,p =NS ;72 .88± 8.2 5、69.67± 8.14、72 .85± 10 .5、76.56± 18.0 4 (min-1) ,p =NS。在握力的状态下 ,对照组和冠心病的一、二、三支冠脉病变组分别为 ( 59.38± 9.4 4 ) %、( 54.4 4± 5.66) %、( 4 8.84± 8.70 ) %、( 4 5.2 5± 8.69) % ,p =NS、<0 .0 5、<0 .0 1;3.52± 0 .33、2 .To assess the influence of isometric handgrip exercise on left ventricular function by radionuclide ventriculogrphy in patients with coronary artery disease (CAD). Using gated equilibrium radionuclide ventriculography, parameters of left ventricular function were andalyzed at rest and during 30% sustained handgrip (HNG) for 5—10 minuets in 8 normal control subjects and 38 consecutive CAD patients. All investigated subjects were also performed coronary arteriography within 2 weeks. Results showed that at rest, left ventricular ejection fraction (LVEF), peak filling rate (PFR), end-diastolic volume (EDV), end-systolic volume (ESV) and heart rate (HR) were reduced in one-vessel, two-vessel and three-vessel of stenosis patient group (53.67±5.0)%, (52.47±8.26)%, (52.81±8.89)%;2.87±0.29, 2.71±0.88, 3.07±0.71 end-diastolic volume per second (EDV/s); 1.36±0.05, 1.34±0.06, 1.34±0.06; 0.62±0.06, 0.66±0.06, 0.65±0.1; 69.67±8.14, 72.85±10.5, 76.56±18.04(min -1 ), respecively, as compared with controls (57±10.45)%,p=NS;2.94±0.44 (EDV/s),p=NS;1.38±0.15,p=NS;0.59±0.11,p=NS;72.88±8.25 (min -1 ),p=NS,respectively. During HNG exercise using both hands, the indexes were reduced in CAD patients (54.44±5.66)%, (48.84±8.70)%, (45.25±8.69)%;2.75±0.39, 2.50±0.68, 2.22±0.58 (EDV/s);1.36±0.05, 1.31±0.06, 1.26±0.07;0.61±0.07, 0.69±0.06, 0.71±0.09;81.33±8.92, 84.46±14.29, 90.56±26.54 (min -1 , respectively, as compared with controls (59.38±9.44)%,p=NS;<0.05,<0.01;3.52±0.33 (EDV/s), P <0.001, P <0.001, P <0.001;1.41±0.16,p=NS;NS,<0.05;0.56±0.11,p=NS;<0.01/<0.01;83.75±7.56 (min -1 ),p=NS, respectively. The four protocols of CAD diagnosis were 1.LVEF<55% and ΔPFR<0 EDV/s at rest (Δ value=during HNG value-rest value);2.LVEF<55% during HNG and ΔPFR<0 EDV/s;3. ΔLVEF<0% and ΔPFR<0 EDV/s;4.ΔEF<0%. Their sensitivity, specificity and accuracy were 45%, 53%, 66%, 76%;100%, 100%, 87.5%, 87.5%;54%, 61%, 70%, 78%, respectively. The isomeric exercise radionuclide ventriculogrphy is

关 键 词：等长运动 心脏功能试验 冠心病 放射性核素显像 心血池显像 诊断 

分 类 号：R817.42[医药卫生—影像医学与核医学] R541.4[医药卫生—放射医学]