孤立性左心室心肌致密化不全患者的心肌灌注显像研究  

Myocardial perfusion abnormalities in patients with isolated left ventricular noncompaction

作　　者：李燕[1] 杨敏福[4] 高晓津[2] 赵世华[3] 杨跃进[2] 

机构地区：[1]北京协和医学院、中国医学科学院国家心血管病中心、阜外心血管病医院、心血管疾病国家重点实验室核医学科,100037 [2]北京协和医学院、中国医学科学院国家心血管病中心、阜外心血管病医院心内科,100037 [3]北京协和医学院、中国医学科学院国家心血管病中心、阜外心血管病医院放射科,100037 [4]首都医科大学附属北京朝阳医院核医学科

出　　处：《中华核医学与分子影像杂志》2014年第5期354-357,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：首都医学发展科研基金联合攻关项目（2009-1004）

摘　　要：目的 分析孤立性左心室心肌致密化不全（ILVNC）患者的心肌灌注受损情况,及其与心脏MRI结果之间的关系.方法 前瞻性入选19例（男14例,女5例,年龄15 ～ 76岁）经心脏MRI确诊的ILVNC患者,同期行99Tcm-MIBI SPECT MPI.采用标准的17节段法分析MRI及SPECT图像.计算MRI所示各节段心肌非致密层（NC）与致密层（C）厚度比值（NC/C）,NC/C＞2.3者诊断为心肌致密化不全.计算并比较致密不全节段和致密化节段延迟强化（DE）出现率及心肌灌注异常的出现率.两样本率的比较采用χ^2检验;lgLVEF（LVEF由MRI测定）和心肌灌注受损节段数、致密化不全节段数和DE节段数的关系采用Pearson或Spearman法分析.结果 19例患者中16例（84.2％） MPI出现灌注受损;MRI示19例共有致密化不全节段107个和致密化节段216个,灌注异常出现率分别为33.6％（36/107）和31.9％（69/216）,差异无统计学意义（χ^2=0.09,P＞0.05）.共31个节段出现DE,致密化不全节段和致密化节段DE出现率分别为5.6％（6/107）和11.6％ （25/216）,差异也没有统计学意义（χ^2=2.94,P＞0.05）.DE节段灌注异常出现率高于非DE节段[54.8％（17/31）与30.1％（88/292）;χ^2=7.80,P＜0.01].lgLVEF与致密化不全节段数、DE节段数、灌注受累节段数间相关系数均无统计学意义（r=-0.35、0.15和-0.34,均P＞0.05）.结论 大部分ILVNC患者存在不同程度的心肌血流灌注受损,MRI所示致密化不全和非致密化不全心肌均可出现;心肌灌注受损在该病的发生及进展中的作用尚需进一步研究.Objective To investigate the myocardial perfusion abnormalities in patients with isolated left ventricular noncompaction （ILVNC） and analyze the correlation between MPI and MRI.Methods Nineteen patients （14 males,5 females,age range：15-76 years） with ILVNC diagnosed by cardiac MRI were recruited.All patients underwent 99Tcm-MIBI MPI.Both MPI and cardiac MRI were analyzed using a 17-segment model.The thickness ratio of the non-compacted to compacted layers of myocardium （NC/C） was calculated,and segments with NC/C＞2.3 were considered as noncompaction.The incidences of delayed enhancement （DE） and myocardial perfusion abnormalities in non-compacted segments and compacted segments were calculated.χ^2 test was used for categorical data.The Pearson and Spearman correlation coefficient were used to assess the relationship between the numbers of myocardial segments with myocardial perfusion abnormalities/noncompaction/DE and lgLVEF.Results Of 19 patients,myocardial perfusion abnormality was found in 16 （84.2％） patients.The incidences of perfusion abnormality were 33.6％ （36/107） in non-compacted segments and 31.9％ （69/216） in compacted segments,respectively （χ^2=0.09,P＞0.05）.There were 31 segments with DE.The incidences of DE were 5.6％ （6/107） in non-compacted segments and 11.6％ （25/216） in compacted segments,respectively （χ^2 =2.94,P＞0.05）.The incidence of reduced perfusion was higher in segments with DE than those in segments without DE （54.8％ （17/31） vs 30.1％ （88/292） ; χ^2 =7.80,P＜0.01）.The lgLVEF and the numbers of myocardial segments with noncompaction/DE/myocardial perfusion abnormalities were not correlated（r=-0.35,0.15,-0.34,all P＞0.05）.Conclusion Most patients with ILVNC have myocardial perfusion abnormality,which can be observed both in non-compacted and compacted myocardium.Further research is required to elucidate the role of myocardial perfusion abnormality in ILVNC.

关 键 词：孤立性心肌致密化不全 体层摄影术 发射型计算机 单光子 磁共振成像 MIBI 

分 类 号：R816.2[医药卫生—放射医学]