核素心肌显像对急性心肌梗死患者PTCA后左心室收缩功能变化的评估价值  

Evaluation value of radionuclide myocardial imaging on left ventricular systolic function changes in patients with acute myocardial infarction after PTCA

作　　者：崔雅丽[1] 刘海燕[1] 秦锐锐 胡光[1] 晋建华[1] Cui Yali;Liu Haiyan;Qin Ruirui;Hu Guang;Jin Jianhua(Department of Nuclear Medicine,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学附属第一医院核医学科,太原030001

出　　处：《国际放射医学核医学杂志》2020年第3期137-142,共6页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的 探讨核素心肌灌注/代谢显像对急性心肌梗死(AMI)患者经皮腔内冠状动脉成形术(PTCA)后左心室收缩功能变化的评估价值.方法 回顾性分析2015年6月至2017年12月于山西医科大学附属第一医院行PTCA治疗的AMI患者36例,其中男性27例、女性9例,年龄(57.9±12.3)岁.所有患者均在AMI发病1周内行PTCA治疗,并于治疗前3天和治疗后6~8个月行99Tcm-甲氧基异丁基异腈SPECT心肌灌注显像(MPI)和18F-氟脱氧葡萄糖PET/CT心肌代谢显像.根据治疗后左心室射血分数(LVEF)的变化值(△LVEF)将患者分为2组:A组为心功能改善组(△LVEF≥5%);B组为心功能未改善组(△LVEF<5%).采用t检验和x2检验分析比较2组患者的临床资料、LVEF、高峰射血率(PER)、存活心肌/坏死心肌节段数(S/N)比值及心肌肌钙蛋白I(cTnI)等指标间的差异;采用Logistic回归分析影响左心室收缩功能的相关因素;采用受试者特征工作(ROC)曲线分析预测LVEF改善(△LVEF≥5%)的S/N界值.结果 (1)2组患者的性别、年龄、体重指数、吸烟史、高血压病史、糖尿病史、高脂血症病史、心绞痛病史等差异均无统计学意义(均P> 0.05).(2)PTCA治疗前,A组和B组间LVEF、PER、cTnI的差异无统计学意义,而S/N比值(A组:1.24±1.06,B组:0.58±0.37)的差异有统计学意义(t=0.824,P=0.042);PTCA治疗后,2组间LVEF(A组:47±12,B组:38±10)、PER(A组:2.11±0.48,B组:1.71±0.50)、S/N比值(A组:0.73±0.47,B组:0.62±0.39)的差异有统计学意义(t=-2.528、-2.366、-2.514,P=0.016、0.024、0.017),但cTnI间的差异无统计学意义.(3) Logistic回归分析显示,S/N比值是△LVEF的独立影响因素(OR=2.164,P=0.018).(4)ROC曲线结果显示,以S/N比值预测AMI患者PTCA治疗后△LVEF≥5%的界值为0.62,曲线下面积为0.823(95%CI:0.661~0.985),特异度为85.71%,灵敏度为91.54%.结论 核素心肌灌注/代谢显像对AMI患者行PTCA治疗后左心室收缩功能变化的评估具有重要的临床价值.Objective To evaluate the value of radionuclide myocardial perfusion/metabolic imaging in the assessment of left ventricular systolic function after percutaneous coronary intervention and percutaneous transluminal coronary angioplasty(PTCA)in patients with acute myocardial infarction(AMI).Methods The present study was a retrospective analysis of 36 patients(male/female,27/9;age,57.9±12.3 years)with AMI who were treated with PTCA in the First Affiliated Hospital of Shanxi Medical University from June 2015 to December 2017.All patients received PTCA treatment within 1 week of onset of AMI.SPECT myocardial perfusion imaging and PET/CT myocardial metabolic imaging were performed 3 days before and 6-8 months after treatment.Patients were then divided into two groups,namely,group A(left ventricular ejection fraction(LVEF)change value(ΔLVEF),ΔLVEF≥5%)and group B(ΔLVEF<5%).The t-andχ2 tests were used to compare differences between the two groups in terms of clinical data(LVEF,peak ejection rate(PER),ratio of surviving myocardium/necrotic myocardium(S/N)and cardiac troponini(cTnI)Logistic regression was used to analyze the factors affecting left ventricular systolic function.Receiver operating characteristic(ROC)curve analysis determined the S/N ratio cutoff for improved LVEF values(ΔLVEF≥5%).Results No statistically significant differences in gender,age,body mass index,history of smoking,hypertension,diabetes,hyperlipidemia,and angina were found between the two groups(all P>0.05).Before PTCA treatment,differences in LVEF,PER,and troponin cTnI between groups A and B were not statistically significant but differences in S/N ratio(group A:1.24±1.06,group B:0.58±0.37)were statistically significant(t=0.824,P=0.042).After PTCA treatment,differences in LVEF(group A:47±12,group B:38±10),PER(group A:2.11±0.48,group B:1.71±0.50),and S/N ratio(group A:0.73±0.47,group B:0.62±0.39)between the two groups were statistically significant(t=-2.528,-2.366,-2.514;P=0.016,0.024,0.017)but the difference in cTnI was not stati

关 键 词：心肌梗死 心肌灌注显像 正电子发射断层显像计算机体层摄影术 血管成形术 气囊 冠状动脉 存活心肌 坏死心肌 

分 类 号：R654.2[医药卫生—外科学]