小剂量多巴酚丁胺负荷超声结合背向散射与负荷核素评价存活心肌的对比研究  

Compared Study of Low Dose Dobutamine Stress Echocardiography Combined with Integrated Backscatter Stress ^(99m)Tc Single Photon Emission Computed Tomography for Evaluating Viable Myocardium in Patients with Coronary Artery Disease

作　　者：常超[1] 刘吉祥[1] 信栓力[1] 李琴[1] 马宝红 杨梅霞 王素兰 张博[1] 杨华[1] 

机构地区：[1]河北省邯郸市第一医院,河北邯郸056002 [2]河北省邯郸市磁县医院

出　　处：《中西医结合心脑血管病杂志》2015年第6期728-730,共3页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：河北省卫生厅医学科学研究重点课题计划(No.20120197)

摘　　要：目的探讨小剂量多巴酚丁胺负荷超声(LDDSE)结合心肌背向散射积分(IBS)检测存活心肌的临床应用价值。方法对照组(CON组)18例,冠状动脉定量造影术(QCA)正常,行二维超声(2DE)、LDDSE结合IBS检查。冠心病组(CAD组)22例,经QCA确诊为冠心病,并行经皮冠脉介入术(PCI),术前1周内行LDDSE[5μg/(kg·min)、10μg/(kg·min)]检查、静息及硝酸甘油(NTG)介入99mTc-甲氧基异丁基异腈单光子发射计算机断层灌注显像(SPECT)检查,于静息、DSE每级负荷5min采集全心尖切面(长轴、二腔、四腔)IBS图像,术后3个月复查二维超声。探索在LDDSE过程中,以CVIB最大变化值(K)>0.7定义为存活心肌,检测其识别存活心肌的准确性,并与LDDSE、SPECT进行比较。结果与LDDSE相比,LDDSE结合IBS技术检测存活心肌敏感性、准确性明显提高(91.1%vs 77.8%;90.4%vs 75.7%,P<0.05);与SPECT相比敏感性、准确性均明显提高(91.1%vs 80.0%;90.4%vs 76.5%,P<0.05)。结论 LDDSE结合IBS技术检测存活心肌准确性较SPECT高,具有临床应用价值。Objective To explore the clinical value of low dose dobutamine(Dob)stress echocardiography(DSE)combined with inte-grated backscatter(IBS)for identifying viable myocardium in patients with coronary artery disease(CAD).Methods Eighteen pa-tients whose results of the quantitative coronary artery were normal underwent the examination of 2 DE,DSE with IBS in group CON.22 patients who were diagnosed CAD by quantitative coronary artery (QCA)in group CAD,percutaneous coronary intervention (PCI)was performed further LDDSE [5,10μg/(kg· min)]and rest/NTG SPECT were checked one week before PCI.IBS images at rest and every grade infusion of Dob 5 minutes were obtained in total apical views(Lax,2 ch,4 ch).Two dimension echocardio-graphy was examined after three months of PCI again.Defining the maximum changing value of CVIB (K)during DSE>0.7 as viable myocardium,then the accuracy in identifying viable myocardium were compared among LDDSE,SPECT and LDDSE combined with IBS.Results The sensitivity,accuracy for identifying viable myocardium were significantly higher by LDDSE combined with IBS than those of LDDSE (sensitivity:91.1% vs 77.8%,accuracy:90.4 vs 75.7%,respectively P<0.05).Compared with SPECT,the sensitivi-ty and accuracy had been significantly improved by LDDSE combined with IBS,whose numbers were 91.1%,90.4% respectively. Conclusion LDDSE combined with IBS identifying viable myocardium has higher accuracy than SPECT,it is more practical in clinic.

关 键 词：多巴酚丁胺 超声心动图 单光子发射计算机断层灌注显像 心肌背向散射 存活心肌 

分 类 号：R542.2[医药卫生—心血管疾病]