ATP负荷99mTc-MIBI门控SPECT/CT心肌灌注显像在心脏X综合征的诊治应用  

Application of ATP Stress 99mTc-MIBI Gated SPECT/CT Myocardial Perfusion Imaging in Diagnosis and Treatment of Cardiac Syndrome X

作　　者：周凡[1] 汪建强[1] 陈春梦 黄静 ZHOU Fan;WANG Jianqiang;CHEN Chunmeng;HUANG Jing(Department of Nuclear Medicine,The Second People's Hospital of Yibin,Yibin Hospital Affiliated to West China Hospital of Sichuan University,Yibin 644000,Sichuan,China;Department of Ultrasound,The Second People's Hospital of Yibin,Yibin Hospital Affiliated to West China Hospital of Sichuan University,Yibin 644000,Sichuan,China)

机构地区：[1]宜宾市第二人民医院核医学科四川大学华西医院宜宾医院,四川宜宾644000 [2]宜宾市第二人民医院超声科四川大学华西医院宜宾医院,四川宜宾644000

出　　处：《心血管病学进展》2020年第9期989-993,共5页Advances in Cardiovascular Diseases

摘　　要：目的探讨心脏X综合征患者心肌缺血临床诊治中ATP负荷99mTc-MIBI门控SPECT/CT心肌灌注显像所发挥的临床作用。方法回顾本院临床诊断心脏X综合征56例,采用ATP负荷/静息门控SPECT/CT心肌灌注显像方法,对左心室心肌短轴和长轴图像进行17节段划分判断心肌缺血部位,应用半定量(0~3分)法判断心肌缺血程度,将左心室射血分数(LVEF)同超声心动图的测值进行比较,同时对患者进行至少1年的随访。结果ATP负荷99mTc-MIBI门控SPECT/CT心肌灌注显像判断心肌缺血者48例,冠状动脉左前降支、左回旋支和右冠状动脉关联区域放射性分布异常节段分别为210个(62.5%)、101个(42.1%)和93个(38.8%),左前降支关联区域核素分布异常节段数高于左回旋支(P<0.05)和右冠状动脉(P<0.05);轻度缺血36例(75.0%),中度缺血10例(20.8%),重度缺血2例(4.2%)。静息状态下测得LVEF(65.59±3.13)%与超声心动图测得LVEF(64.22±3.12)%比较,二者差异无统计学意义(P>0.05)。随访39例心肌缺血患者,无心脏事件发生,心肌缺血症状明显好转。结论ATP负荷99mTc-MIBI门控SPECT/CT心肌灌注显像能准确地判断心脏X综合征患者心肌缺血部位、程度及左心功能,对临床医师治疗决策具有指导价值。Objective To investigate the clinical effect of ATP stress 99mTc-MIBI gated SPECT/CT myocardial perfusion imaging(SPECT/CT-G-MPI)in the clinical diagnosis and treatment of myocardial ischemia in cardiac syndrome X patients.Methods A total of 56 patients with cardiac syndrome X clinically diagnosed in our hospital were reviewed.The short and long axis images of left ventricular myocardium were divided into 17 segments using ATP-loaded/resting-state SPECT/CT-G-MPI.The degree of myocardial ischemia was evaluated by semi-quantitative(0~3 points)method,and the left ventricular ejection fraction(LVEF)was compared with that of echocardiography.In addition,the patients were followed up for at least 1 year.Results ATP stress 99mTc-MIBI SPECT/CT-G-MPI detected myocardial ischemia in 48 patients.The abnormal radioactive distribution of left anterior descending branch,left circumflex branch and right coronary artery were 210(62.5%),101(42.1%)and 93(38.8%),respectively.The number of abnormal nuclide distribution in the left anterior descending branch was higher than that in the left circumflex branch(P<0.05)and the right coronary artery(P<0.05).There were 36 patients(75.0%)with mild ischemia,10 patients(20.8%)with moderate ischemia,and 2 patients(4.2%)with severe ischemia.No statistically significant difference was found between LVEF[(65.59±3.13)%]measured in the resting state and LVEF[(64.22±3.12)%]by echocardiography(P>0.05).Follow-up of 39 patients with myocardial ischemia showed that no cardiac events occurred,and the symptoms of myocardial ischemia were significantly improved.Conclusion ATP stress 99mTc-MIBI SPECT/CT-G-MPI can accurately determine the location,degree and left ventricular function of myocardial ischemia in cardiac syndrome X patients,and has guiding value for clinicians to make treatment decision.

关 键 词：三磷酸腺苷 99MTC-MIBI 门控心肌灌注显像 

分 类 号：R541.4[医药卫生—心血管疾病]