心脏X综合征患者核素心肌灌注显像特点及性别差异  

Characteristics and gender differences of gated myocardial perfusion imaging in patients with cardiac syndrome X

作　　者：李如意[1] 王学超[1] 胡玉敬[2] 李鑫柠[1] 张丽娜[1] 

机构地区：[1]河北省人民医院心内科,河北石家庄050051 [2]河北省人民医院核医学科,河北石家庄050051

出　　处：《临床荟萃》2015年第12期1347-1349,共3页Clinical Focus

摘　　要：目的探讨心脏X综合征患者核素心肌灌注显像的特点及性别差异。方法 36例经冠状动脉造影或冠状动脉计算机断层血管造影术及临床确诊为心脏X综合征患者,行静息/负荷99m锝甲氧基异丁基异腈(99mTcMIBI)门控心肌灌注显像(G-MPI),对比负荷和静息状态下核素分布情况评价心肌缺血的特点,同时对不同性别心脏X综合征患者临床危险因素及核素心肌灌注显像特点进行分析。结果经静息/负荷99mTc-MIBI G-MPI确诊的36例X综合征患者中23例(63.9%)为可逆性缺损,9例(25.0%)为固定性缺损,4例(11.1%)为反向再分布。全部468个左心室心肌节段中,负荷状态下127个(30.0%)节段表现为核素分布减低,前壁、下壁心肌灌注异常节段的比率均高于侧壁,差异均有统计学意义(P<0.05),男女患者在缺血程度上无明显差异,但女性患者以前壁缺血为主,而男性患者以前壁和下壁缺血为主(P<0.05)。全部入选的36例患者心肌灌注显示异常冠状动脉共19支,左前降支心肌灌注异常的比率高于冠状动脉左回旋支及右冠状动脉(P<0.05)。全部入选的36例心脏X综合征患者,女性14例(38.9%),与男性患者相比,女性患者年龄更大,体质量指数较高,合并高血脂、糖尿病史较多(P均<0.05),血清胆固醇、低密度脂蛋白胆固醇及尿酸水平较高(P均<0.05),吸烟史较少(P<0.05),两组患者高血压病史差异无统计学意义。结论静息/负荷99mTc-MIBI G-MPI对诊断心脏X综合征及评价心肌缺血具有重要的临床价值。Objective To investigate the characteristics and gender differences of gated myocardial perfusion imaging in patients with cardiac syndrome X.Methods A total of 36 patients with cardiac syndrome X were examined by the rest/stress 99mTc-MIBI gated myocardial perfusion imaging（G-MPI）.The characteristics of myocardial ischemia were evaluated between rest G-MPI and stress G-MPI.The clinical risk factors and characteristics of G-MPI in different genders of patients with cardiac syndrome X were analyzed.Results A total of 36 patients showed abnormal ^99mTc-MIBI G-MPI,including 23cases（63.9%）of reversible defect,9cases（25.0%）of fixed defect,4cases（11.1%）of reverse redistribution.A total of 127cases（30.0%）showed decreased left ventricular myocardial segmental radionuclide distribution,the abnormal perfusion rates in anterior and inferior walls were significantly higher than those in the lateral wall（P〈0.05）.There was no gender difference in the extent of myocardial ischemia,but female patients showed more myocardial ischemia in anterior wall,male patients showed more myocardial ischemia in anterior wall and inferior wall.The rate of abnormal radionuclide distributions in left anterior descending artery（LAD）was significantly higher than that in right coronary artery（RCA）and left circumflex artery（LCX）（P〈0.05）.Compared with the male patients,the females had higher age,bigger BMI（P〈0.05）.The history of hyperlipidemia and diabetes were more common in female patients.TC,LDL and UA were also significantly higher in female patients,but the rate of smoking was significantly lower in female patients（P〈0.05）.There was no significant difference in hypertension history between males and females.Conclusion Rest/stress 99mTc-MIBI G-MPI has an important value for diagnozing cardiac syndrome X and evaluating the myocardial ischemia.

关 键 词：微血管性心绞痛 放射性核素显像 诊断 鉴别 

分 类 号：R541.4[医药卫生—心血管疾病]