纯合子家族性高胆固醇血症核素心肌灌注显像的特点  

Features of radionuclide myocardial perfusion imaging in patients with homozygous familial hypercholesterolemia

作　　者：焦建[1] 王绿娅[2] 米宏志[1] 牟甜甜[1] 李珺奇[1] 张晓丽[1] Jiao Jian;Wang Luya;Mi Hongzhi;Mou Tiantian;Li Junqi;Zhang Xiaoli(Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China （Jiao J, Mi HZ, Mou TT, Li JQ, Zhang XL;Department of Atherosclerosis Research Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China （ Wang LY)

机构地区：[1]首都医科大学附属北京安贞医院核医学科,100029 [2]首都医科大学附属北京安贞医院动脉硬化研究室,100029

出　　处：《中华核医学与分子影像杂志》2018年第6期381-384,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨家族性高胆固醇血症纯合子（HoFH）患者核素心肌灌注显像（MPI）特点及其影响因素。方法回顾性研究2010年6月至2016年11月间经临床和染色体检测确诊为HoFH的42例患者[男21例，女21例；平均年龄（14.8±8.4）岁]，均行两日法的ATP负荷和静息99Tcm－甲氧基异丁基异腈（MIBI）SPECT MPI，获取MPI负荷灌注总积分（SSS）、静息灌注总积分（SRS）及两者差值分（SDS；SSS－SRS）。分析MPI图像特点及SSS、SRS、SDS与年龄、血脂等指标的相关性。采用两样本t检验、χ^2检验、多元线性回归和多因素logistic回归分析处理数据。结果42例HoFH患者中，MPI阳性（SSS≥1）24例，女性MPI阳性率较男性高[76.2%（16/21）与38.1%（8/21）; χ^2＝6.22, P〈0.05]；MPI阴性18例。〈10岁组（14例）、10～18岁组（14例）和≥19岁组（14例）患者MPI阳性例数逐渐增加（6、8和10例），但3组间差异无统计学意义（χ^2＝2.33, P〉0.05）。ATP负荷试验中12例患者心电图阳性，女性心电图阳性率高于男性[42.9%（9/21）与14.3%（3/21）; χ^2＝4.20, P〈0.05]。63个（8.8%，63/714）心肌节段有心肌灌注异常（SSS≥1），主要分布在左前降支供血区（60.3%, 38/63）。SSS的危险因素为年龄和高密度脂蛋白胆固醇（HDLC），SRS、SDS的危险因素分别为HDLC和年龄。多因素logistic回归分析显示，女性是预测MPI阳性的唯一独立危险因素（比值比为5.2，95% CI：1.363～19.774）。结论HoFH患者发生MPI异常有随着年龄增加而上升的趋势，女性患者更易出现。心肌灌注异常的部位主要位于左前降支供血区。年龄和性别是HoFH患者MPI异常的影响因素。ObjectiveTo evaluate the features of myocardial perfusion imaging （MPI） in patients with homozygous familial hypercholesterolemia （HoFH） and its influence factors.MethodsForty-two consecutive HoFH patients （21 males, 21 females; average age： （14.8±8.4） years） were retrospectively enrolled in this study from June 2010 to November 2016. Diagnosis was proved by clinical and chromosome tests, and all patients underwent ATP stress and rest 99Tcm-methoxyisobutylisonitrile （MIBI） SPECT MPI with a two-day protocol. Summed stress score （SSS） and summed rest score （SRS） were acquired, and summed difference score （SDS; SSS-SRS） was calculated. Relations between SSS, SRS, SDS and age, lipid profile were analyzed. Two-sample t test, χ^2 test, multiple linear regression analysis and multivariate logistic regression were used to analyze the data.ResultsThere were 24 patients with positive MPI results （SSS≥1）, and females （76.2%, 16/21） showed more positive MPI results than males （38.1%, 8/21; χ^2=6.22, P〈0.05）. Eighteen patients had negative MPI results. There were 6, 8, 10 patients with MPI positive results in 〈10 years group （n=14）, 10-18 years group （n=14） and ≥19 years group, respectively （χ^2=2.33, P〉0.05）. Positive electrocardiograph （ECG） in ATP stress test was observed in 9 females （42.9%, 9/21） and 3 males （14.3%, 3/21; χ^2=4.20, P〈0.05）. Sixty-three （8.8%, 63/714） abnormal myocardial perfusion segments （SSS≥1） were found, which was mainly （60.3%, 38/63） distributed in myocardial regions supplied by left anterior descending branch （LAD）. SSS was positively correlated with age and high density lipoprotein cholesterol （HDLC）. SRS, SDS were positively correlated with HDLC and age respectively. Multivariate logistic regression analysis indicated that the female was the only independent risk factor to predict positive MPI （odds ratio=5.2, 95% CI： 1.363-19.774）.ConclusionsIn HoFH patients, abnormal myocardial pe

关 键 词：高脂蛋白血症Ⅱ型 纯合子 心肌灌注显像 体层摄影术 发射型计算机 单光子 99M锝甲氧基异丁基异腈 

分 类 号：R589.2[医药卫生—内分泌] R816[医药卫生—内科学]