存活心肌数量与冠心病患者冠状动脉旁路移植术后左心室容积变化的关系  

Predictive value of myocardial viability on the volume change of left ventricle after coronary artery bypass graft

作　　者：王跃涛[1] 杨彦松[1] 张晓膺[2] 钱永祥[2] 狄冬梅[2] 邵晓梁[1] 王建锋[1] 王小松[1] 邵小南[1] 

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院核医学科,213003 [2]苏州大学附属第三医院、常州市第一人民医院心胸外科,213003

出　　处：《中华核医学与分子影像杂志》2016年第6期500-506,共7页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金（81471690）;江苏省省级重点研发专项基金（BE2015635）

摘　　要：目的 探讨PET心肌代谢显像结合心肌灌注显像评估存活心肌数量与冠心病患者冠状动脉旁路移植术（CABG）后左心室容积变化的关系。方法 前瞻性入选苏州大学附属第三医院心胸外科2013年12月至2014年12月行CABG的冠心病患者39例[男37例、女2例，平均年龄（64±9）岁]，术前进行99Tcm－MIBI GSMPI和18F－FDG PET心肌代谢显像评估存活心肌，术后3～6个月随访并复查GSMPI。根据术后EDV和（或）ESV减少10%及以上判断为左心室容积减小，将患者分成左心室容积减小组和左心室容积未减小组。采用独立样本t检验、χ2检验和秩和检验分析2组患者相关临床指标及存活心肌节段数、瘢痕心肌节段数等指标间的差异，用logistic回归分析相关指标与左心室容积变化之间的关系，用ROC曲线寻找预测术后左心室容积减小的存活心肌数量界值。结果 （1）39例冠心病患者CABG术后26例左心室容积较术前减小，13例左心室容积未减小。（2）左心室容积减小组存活心肌节段数明显高于左心室容积未减小组（4.5±2.8和2.4±1.5；t＝－3.011，P〈0.05），瘢痕心肌节段数明显少于左心室容积未减小组[0（0，1.0）和1.0（0，2.0）；z＝－2.084，P〈0.05]，差异有统计学意义。2组间性别、年龄、BMI、高血压病史、糖尿病史、高脂血症病史、心绞痛病史、CCS分级、NYHA分级、EDV、ESV、LVEF、术前肌酐、Gensini score、正常心肌节段数、术后GSMPI时间差异均无统计学意义（t＝－0.253～1.522, χ2＝－1.014～1.251，均P〉0.05）。（3）Logistic回归分析显示，存活心肌节段数是冠心病患者CABG术后左心室容积减小的独立影响因素[比值比（OR）＝2.462，P〈0.05]。（4）ROC曲线示，存活心肌数量预测CABG术后左心室容积减小的界值为存活心肌节段数≥3，AUC为0.743，其灵敏度、特异性、准确性均为76.92%（10/13、20/26和30/39）。（5）�Objective To evaluate the predictive role of myocardial viability assessed by 99Tcm-MIBI GSMPI and 18F-FDG PET on the volume change of the left ventricle（LV） after coronary artery bypass graft （CABG） operation.Methods From December 2013 to December 2014, 39 patients （37 males, 2 females; average age （64±9） years） with ischemic cardiomyopathy planned for surgical revascularization in the Third Affiliated Hospital of Soochow University were prospectively recruited. All patients underwent 99Tcm-MIBI GSMPI and myocardial 18F-FDG PET to assess myocardial viability preoperatively and GSMPI to assess myocardial perfusion 3-6 months after CABG. Reduction of LV volume ≥10% was considered significant. Patients were divided into two groups based on the reduction of LV volume, and the clinical data were compared between the two groups including gender, age, BMI, history of hypertension, diabetes, hyperlipidemia, angina pectoris, CCS classification for angina pectoris, NYHA classification for functional status, EDV, ESV, LVEF, preoperative creatinine, Gensini score, the number of viable myocardium, scar and normal myocardium and follow-up duration, by independent-sample t test, χ2 test and Mann-Whitney test. Multivariate logistic regression analysis was performed to determine the factors to predict reduction of LV volume after revascularization. ROC curve analysis was performed to determine the cut off number of hibernating segments for reduction of LV volume after revascularization.Results The number of viable segments in the reduced group （n=26） was significantly higher than that in the non-reduced group （（n=13; 4.5±2.8 vs 2.4±1.5; t=-3.011, P〈0.05） and the number of scarring segments in the reduced group was significantly less than that in the non-reduced group （0（0, 1.0） and 1.0（0, 2.0）; z=-2.084, P〈0.05）. The clinical data between the 2 groups were not significantly different（t： -0.253 to 1.522, χ2： -1.014 to 1.251, all P〉0.05）. The number of viable segments was

关 键 词：冠状动脉疾病 冠状动脉分流术 心肌 心室功能 左 体层摄影术 发射型计算机 体层摄影术 发射型计算机 单光子 脱氧葡萄糖 MIBI 

分 类 号：R654.2[医药卫生—外科学] R816.2[医药卫生—临床医学]