心肌灌注显像联合CT冠状动脉造影在冠心病患者中的预后诊断价值  

Prognostic value of SPECT myocardial perfusion imaging combined with CT coronary angiography in patients with suspected or diagnosed coronary diseases

作　　者：汪娇[1] 李剑明[1] WANG JIAO;LI Jian-ming(TEDA International Cardiovascular Hospital and Tianjin Medical University Clinical Cardiovascular College, Tianjin 300457, China)

机构地区：[1]泰达国际心血管病医院天津医科大学心血管病临床学院

出　　处：《医疗卫生装备》2019年第7期49-53,69,共6页Chinese Medical Equipment Journal

摘　　要：目的:探讨SPECT心肌灌注显像(myocardial perfusion imaging,MPI)联合CT冠状动脉造影(CT coronary angiography,CTCA)在可疑或确诊冠心病患者中的预后诊断价值,明确MPI联合CTCA阳性或阴性对心脏不良事件的预测价值。方法:MPI单独分组:无缺血组(阴性组)和缺血组(阳性组)。CTCA单独分组:CTCA阴性组(无狭窄)、轻度狭窄组(0<冠状动脉狭窄<50%)、中度狭窄组(50%≤冠状动脉狭窄<75%)和重度狭窄组(冠状动脉狭窄≥75%)。纳入具备同期CTCA和MPI者联合分组:CTCA阴性组、轻度狭窄组、中度狭窄组和重度狭窄组各组分别分为MPI无缺血亚组(阴性亚组)和MPI缺血亚组(阳性亚组)。对比分析CTCA不同狭窄程度与MPI诊断冠心病的异同点;对各组患者随访,记录主要心脏不良事件(major adverse cardiac events,MACE)的发生率。采用Fisher精确分析或卡方及卡方分割分析各组发生率差别的统计学意义;统计学分析采用SPSS 19.0软件处理。结果:MPI单独分组:MPI阳性组MACE发生率较高,与阴性组相比,差异具有统计学意义(P<0.05);CTCA单独分组:各组间MACE发生率差异有统计学意义(P<0.05);CTCA与MPI联合分组:各组间MACE发生率差异有统计学意义(P<0.05)。结论:MPI联合CTCA能对可疑或确诊冠心病患者准确估计预后,二者阳性或阴性匹配具有较强的预测价值。CTCA有明显狭窄同时伴有MPI血流动力学异常者是MACE的强烈预测因子。Objective To investigate the prognostic values of SPECT myocardial perfusion imaging(MPI) combined with computer tomography coronary angiography(CTCA) in the patients with suspected or confirmed coronary heart diseases, and to determine the predictive value of MPI combined with CTCA positive or negative for adverse cardiac events. Methods MPI results were divided into an ischemia group and a non-ischemia group;CTCA results were divided into four groups including a negative group, a mild stenosis group(0 <coronary stenosis<50%), a moderate stenosis group(50%≤coronary stenosis<75%)and a severe stenosis group(coronary stenosis ≥75%);the results by combined MPI and CTCA were divided into a CTCA negative group, an mild stenosis group, a moderate stenosis group and a severe stenosis group, which were all re-divided into a MPI non-ischemia subgroup(negative subgroup) and MPI ischemia subgroup(positive subgroup) respectively. The differences and similarities between different degrees of CTCA stenosis and MPI were compared and analyzed. The patients in each group were followed up to record the incidence of major adverse cardiac events(MACE). The incidence rates had their statistical differences analyzed by Fisher accurate analysis or chi-square and chi-square segmentation analysis. SPSS 19.0 software was used for statistical analysis. Results MACE had a significantly higher incidence rate in MPI positive group than in negative group(P<0.05);there were statistical differences between CTCA groups(P <0.05);there were obviously different MACE incidence rates in the groups by combined CTCA and MPI(P<0.05). Conclusion MPI combined with CTCA can accurately estimate the prognosis of the patients with suspected or confirmed coronary heart disease. Both positive and negative matches have strong prognostic values. The coronary significant stenosis of CTCA with abnormal MPI is a strong predictor of MACE in the future.

关 键 词：SPECT CT冠状动脉造影 心肌灌注显像 冠状动脉疾病 主要心脏不良事件 冠状动脉狭窄 心肌缺血 

分 类 号：R318[医药卫生—生物医学工程] R814.42[医药卫生—基础医学]