18FDG和^(99m)Tc-MIBI双核素心肌显像对冠状动脉闭塞性缺血性心肌病治疗的临床价值  

Predictive value of radionuclide myocardial perfusion /metabolic imaging technology(^(99m)Tc-MIBI / 18Ffluorodeoxyglucose) in treatment for coronary artery occlusive ischemic cardiomyopathy

作　　者：赵曼[1] 徐予[1] 朱中玉[1] 安松涛[1] 赵先锋[1] 陈芳[1] 

机构地区：[1]河南省人民医院心内科,河南郑州450000

出　　处：《中国现代医学杂志》2015年第30期53-56,共4页China Journal of Modern Medicine

摘　　要：目的对单支或多支冠状动脉完全闭塞性缺血性心肌病患者,进行99m Tc-mibi/18F-FDG双核素心肌断层显像检测,以评价其对药物治疗或经皮冠状动脉介入治疗(PCI)术治疗冠状动脉闭塞性缺血性心肌病预测价值。方法 139例冠状动脉造影证实为单支或多支冠状动脉完全闭塞缺血性心肌病患者行18F-FDG/99m TcMIBI双核素心肌断层显像,根据其结果分为有存活心肌组及无存活心肌组。2组分别根据是否进行PCI治疗再分为2个亚组:PCI+优化药物治疗亚组和优化药物治疗亚组,治疗12个月。以治疗前、后超声左室射血分数(LVEF)、血浆NT-B型脑钠肽前体(NT-pro BNP)水平评价治疗疗效。结果存活心肌组接受PCI+优化药物治疗亚组54例,优化药物治疗亚组24例。治疗前LVEF、NT-pro BNP水平差异无统计学意义。与治疗前比较,两亚组治疗后LVEF均有增加,血NT-pro BNP水平均显著下降,差异有统计学意义。但PCI+优化药物治疗组LVEF、NT-pro BNP水平均较优化药物治疗组进一步改善,差异有统计学意义。无存活心肌组中PCI+优化药物治疗亚组27例,优化药物治疗亚组34例。与治疗前比较,两亚组治疗后LVEF、血NT-pro BNP之间差异均无统计学意义;两亚组治疗后比较,差异无统计学意义。结论药物治疗或PCI术治疗仅对经双核素心肌断层显像证实有存活心肌的冠状动脉闭塞性缺血性心肌病患者有显著疗效。【Objective】 To evaluate the predictive value of radionuclide myocardial perfusion / metabolic imaging technology [99mTc-MIBI / 18F-fluorodeoxyglucose（18F-FDG）] in the treatment for coronary artery occlusive ischemic cardiomyopathy.【Methods】 Totally 139 patients with ischemic cardiomyopathy associated with single or multiple coronary artery occlusion confirmed by coronary artery angiography were enrolled in this study.These patients were divided into survival myocardium and non-survival myocardium groups according to the99mTc-MIBI / 18F-FDG dual isotope SPECT myocardial imaging.According to whether receiving percutaneous coronary intervention（PCI） treatment,both groups were further divided into two subgroups：PCI ＋ optimal medical therapy and simple optimal medical therapy subgroups.The course of treatment lasted for 12 months.Left ventricular ejection fraction（LVEF） and plasma level of N-terminal probrain natriuretic peptide（NT-pro BNP） before and after treatment were used to evaluate the treatment efficacy.【Results】 In the survival myocardium group,LVEF was increased and the NT-pro BNP level decreased significantly after treatment in both subgroups.However,compared with the patients only receiving optimal medical therapy,LVEF and NT-pro BNP level were further significantly improved after treatment in the patients receiving optimal medical therapy combined with PCI.In the non-survival myocardium group,no significant difference was found in LVEF or NT-pro BNP level in both subgroups after treatment compared to that before treatment,there was no significant difference between both subgroups after treatment.【Conclusions】 Drug treatment or PCI treatment is obviously effective only for the subjects with the myocardial viability among the patients with ischemic cardiomyopathy associated with single or multiple coronary artery occlusion.

关 键 词：双核素心肌灌注/代谢显像技术 经皮冠状动脉支架术 左心室射血分数 存活心肌 NT-pro BNP 

分 类 号：R541.4[医药卫生—心血管疾病]