核素心肌灌注显像评价FH纯合子患者心肌血供异常临床意义初步研究  

A study on the clinical significance of abnormal myocardial blood supply in homozygote patients with familial hypercholesterolemia by myocardial perfusion imaging

作　　者：焦建[1] 王绿娅[1] 王蒨[1] 米宏志[1] 李珺奇[1] 董薇[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所核医学科,100029

出　　处：《心肺血管病杂志》2015年第1期42-45,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生局首都医学发展基金(编号20073089);首都医科大学附属北京安贞医院院长科技发展基金(编号2010C01)

摘　　要：目的：利用核素心肌灌注显像（MPI）研究家族性高胆固醇血症（FH）纯合子患者病情进展对心肌血供的影响及临床意义.方法：以经染色体检测确诊并来我院检查的28例FH纯合子患者为研究对象,均行药物负荷/静息MPI,根据心肌血供异常与否,将患者分成两组,并对两组患者的基本资料、血脂水平及心肌血流灌注情况进行对比分析,其中8例患者随诊1～2年.结果：28例FH患者,男性17例,女性11例,平均年龄12.12岁,TC （16.00 ±2.92） mmol/L,LDLC（13.82 ±2.73） mmol/L;MPI示15例阴性（男/女=11/4例）,13例阳性（男/女=6/7例）.负荷试验中6例出现心电图ST段下移性改变.MPI显示：13例MPI阳性患者共计221个心肌节段中,29个节段出现心肌缺血（13.1％）;其中左前降支、回旋支、右冠状动脉供血区分别有21个节段（21/29,72.4％）、5个节段（5/29,17.2％）、3个节段（3/29,10.3％）.MPI阳性与阴性两组中,患者的年龄（P =0.621）、身高（P =0.219）、体质量（P =0.847）、体质量指数（P=0.155）、治疗时间（P=0.189）、性别（P =0.246）、心电图ST段有无下移（P =0.372）、TC（P=0.088）、LDL-C（P=0.082）、TG（P =0.062）、HDL-C（P=0.652）均差异无统计学意义.8例随诊患者复查MPI结果提示：4例原无心肌缺血现仍为阴性;4例原有心肌缺血者,3例心肌缺血范围和程度均无明显变化,1例因心肌缺血程度加重导致心力衰竭后死亡.结论：FH纯合子患者心肌缺血好发于左前降支供血区,且患者的年龄、身高、体质量、治疗时间、血脂等因素在MPI阳性组与阴性组中的差异无统计学意义;最好早期对FH纯合子患者行MPI以评估心血管病危险度分层、患者治疗效果和预后.Objective：Investigating the effect and clinical value to myocardial blood supply in homozy- gous patients with the progress of familial hypercholesterolemia（FH） by myocardial perfusion imaging （MPI）. Methods：As the objects,28 FH patients diagnosed by gene underwent drug induced stress/rest MPI. Put the patients into 2 groups according to whether the myocardial blood supply is normal or not and analyze the basic data, blood lipid and MPI data of patients statistically. 8 patients were followed in 1-2 years. Results： Among 28 patients,17 males and 11 females, mean age （ 12. 12 ± 6. 4） years, TC （ 16. 00 ± 2. 92 ） mmol/L, LDL-C （ 13.82 ± 2. 73 ） mmol/L ; MPI showed 15 uegtive （ male/female = 11/4 ） and 13 positive （ male/female = 6/7 ）. ST segments of ECG moved down in 6 patients in stress test. There were myocardial ischemia in 29 myocardial segments（ 13. 12% ） in all 221 ones of 13 positive patients with MPI, and among 29 myocardial segments,21 （21/29,72. 41% ）,5（5/29,17.24% ）,3（3/29,10. 34% ）ones belonged to the blood-supply areas of the left anterior descending, the left circumflex artery and the right coronary artery respectively. In the positive and neg- tire groups of MPI, there were no significant differences in the patients of age, height, weight, BMI, treatment time,gender,moving down of ST segment in ECG,TC,LDLC,TG and HDLC. The MPI of 8 followed patients showed that：the results of 4 patients who underwent MPI with no myocardial ischemia previously were still neg- tire, and with the positive MPI patients, the area, extent of ischemia in 3 patients had no change, 1 patient got more serious myocardial ischemia and was dead subsequently because of heart failure. Conclusion： The ische- mia area with FH homozygous patients was easy uccur in left anterior descending artery, and the myocardial is- chemia had no obvious correlation with age, height, weight, treatment time and blood lipid and so on. They should be undergone MPI as earlier as possibIe to eval

关 键 词：家族性高胆固醇血症 纯合子 心肌灌注显像 心肌缺血 

分 类 号：R54[医药卫生—心血管疾病]