心肌显像肺摄取定量分析对心肌梗塞患者临床和预后判断的价值  

CLINICAL AND PROGNOSTIC VALUE OF LUNG^(99m)Tc-MIBI UPTAKE ON REST MYOCARDIAL PERFUSION IMAGING FOR PATIENTS WITH MYOCARDIAL INFARCTION

作　　者：王跃涛 鹿存芝 孙珍珠 夏淑珍 

机构地区：[1]徐州市心血管病研究所,221009

出　　处：《中国现代医学杂志》2001年第11期42-43,45,共3页China Journal of Modern Medicine

摘　　要：目的 :探讨99mTc -MIBI静息心肌显像肺摄取对心肌梗塞患者临床和预后判断的价值。方法 :74例行静息心肌显像的心肌梗塞患者按肺摄取值分为肺摄取增加组和正常组 ,并对其随访 ,随访时间平均为 2 3个月。心脏事件包括 :心源性死亡 ,非致死性心肌梗塞 ,心肌显像 3个月后的血运重建术 (CABG或PTCA)。结果 :肺摄取增加组较正常组有较高比例的心力衰竭 (P <0 .0 0 1)和左室扩大 (P <0 .0 1) ,较多的心肌缺损节段数 (P<0 .0 1)和病变血管数 (P <0 .0 1) ,较高的心肌异常灌注积分 (P <0 .0 5 )。逐步判别分析显示 ,心力衰竭是肺摄取增加最重要的影响因素 (F =2 6 .2 0 ,P <0 .0 0 1)。肺摄取增加组心脏事件发生率 (5 3.8%)显著高于正常组 (18.8%) (P <0 .0 1) ,Log -rank统计分析两组未发生心脏事件率差异有显著性 (P <0 .0 5 )。Cox多元回归显示 ,肺摄取增加是发生心脏事件独立的影响因素 (RR =6 .0 5 ,95 %CI 1.92～ 16 .83,P <0 .0 1)。结论 :99mTc-MIBI静息心肌显像肺摄取分析能提供左心功能等有用信息 ,肺摄取增加是心肌梗塞患者不良预后的独立预测指标。Objective:To evaluate the clinical and prognostic value of lung 99m Tc-MIBI uptake on rest myocardial perfusion imaging for patients with myocardial infarction (MI).Methods:Seventy-four patients with MI who underwent 99m Tc-MIBI rest myocardial perfusion tomography were divided into increased lung uptake group and normal lung uptake group.We followed up on patients with no cardiac events (CE) for 23 months on average (rang4～36months) .Death due to primary cardiac cause,or nonfatal myocardial reinfarction,CABG or PTCA occurring >3months after rest myocardial perfusion imaging were considered CE.Results:Increased lung uptake group had higher incidence of heart failure (21 of 26 vs 18 of 48,P<0.001) and left ventricular dilatation (20 of 26 vs 20 of 47,P<0.01),larger numbers of segmental defects (3.73±0.78 vs 3.04±0.77,P<0.01)and lesion vessels (2.38±0.80 vs 1.75±0.75,P<0.01),and higher abnormal myocardial perfusion score (12.04±2.29 vs 10.42±3.30,P<0.05)compared with normal lung uptake group.On stepwise discriminatory analysis,heart failure emerged to be the most important influential factor(F=26.20,P<0.01) of increased lung uptake.During the follow-up period,there were 23 CE.CE occured in 53.8%(14/26) patients with increased lung uptake,compared with 18.8%(9/48) patients with normal lung uptake (χ 2=9.70,P<0.01).Patients with increased lung uptake had a significant lower no-CE rates than those with normal lung uptake (χ 2=5.35,P<0.05,Log-rank test).By multivariate Cox regeression analysis,we found that increased lung uptake was an independent predictor of CE (RR=6.05,95%CI1.92～16.83,P<0.01).Conclusions:In patients with MI,lung uptake on 99m Tc-MIBI rest myocardial perfusion imaging gives clinical useful information in the evaluation of left ventricular function,and increased lung uptake is an important independent predictor of a bad prognosis.

关 键 词：心肌显像 心肌梗塞 肺摄取 定量分析 预后 

分 类 号：R542.22[医药卫生—心血管疾病]