空腹血糖水平对冠心病患者核素心肌代谢显像质量的影响  

Effects of fasting blood glucose levels on the quality of radionuclide imaging of myocardial metabolism in patients with coronary heart disease

作　　者：史晓鹏 周迎生[1] 张晓丽[2] Shi Xiaopeng;Zhou Yingsheng;Zhang Xiaoli(Department of Endocrinology and Metabolism,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Nuclear Medicine,Laboratory for Molecular Imaging,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院内分泌与代谢科,北京100029 [2]首都医科大学附属北京安贞医院核医学科、分子影像中心,北京100029

出　　处：《中华老年医学杂志》2021年第5期596-600,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81641027);北京市科技计划(Z131100004013044);北京市学科带头人基金资助项目(2013-2-006);北京市朝阳区科学技术和信息化局(CYSF1921)。

摘　　要：目的探讨空腹血糖水平对冠心病患者正电子发射断层扫描显像/X射线计算机体层扫描(PET/CT)心肌代谢显像质量的影响。方法回顾分析2019至2020年在北京安贞医院完成18F-脱氧葡萄糖(18F-FDG)PET/CT心肌代谢显像检查的78例冠心病患者的资料,64例符合入选标准。所有患者禁食8 h以上,口服葡萄糖后静脉注射胰岛素和显像剂18F-FDG,完成心肌代谢图像采集。心肌代谢图像质量不影响临床诊断为合格,图像质量评分(IQ)0~2分;否则为不合格,评分为3~4分。分析比较合格组(55例)与不合格组(19例)患者性别、年龄、糖尿病患病率、体质指数、空腹血糖、糖化血红蛋白、糖化血清白蛋白、三酰甘油、游离脂肪酸以及服用调脂药、口服降糖药等差异及其影响因素。结果心肌代谢显像不合格组的糖尿病患病率高于合格组(63.2%和33.3%,χ^(2)=4.872,P=0.027)。不合格组患者空腹血糖、糖化血红蛋白及糖化血清白蛋白水平较合格组升高[7.67(6.02,11.64)和5.52(4.97,6.37)mmol/L;7.30(6.43,8.70)和6.20(5.60,6.87)%;19.8(15.1,24.1)和14.8(13.9,16.8)%,U=-3.909、-2.419和-3.042,P<0.001,P=0.016和0.002]。多因素Logistic回归分析显示空腹血糖是18F-FDG PET/CT心肌代谢显像质量不合格的独立危险因素,OR值1.62(95%CI:1.19~2.20,P=0.002)。空腹血糖≥6.66 mmol/L则是心肌显像不合格的ROC曲线下面积为0.81(95%CI:0.69~0.93,P<0.001)。结论空腹血糖水平是影响18F-FDG PET/CT心肌代谢显像质量的独立危险因素,糖尿病患者应积极控制血糖。Objective To investigate the effects of fasting blood glucose levels on the quality of myocardial metabolism imaging via positron emission tomography/X-ray computed tomography(PET/CT)in patients with coronary heart disease.Methods A total of 78 patients with coronary heart disease from 2019 to 2020 undergone 18-fluorine deoxyglucose(18F-FDG)PET/CT myocardial imaging in Beijing Anzhen Hospital were retrospectively analyzed,with 64 patients meeting the inclusion criteria eventually enrolled in this study.All patients fasted over 8 hours and were injected with insulin and 18F-FDG following an oral glucose load.Then myocardial imaging evaluations were performed.Depending on whether the myocardial image quality(IQ)offered a match with clinical diagnosis,a score between 0-2 from the semiquantitative scoring system was defined as good IQ,while a score between 3-4 defined as poor IQ.Differences in sex,age,rate of diabetes,body mass index,fasting blood glucose(FBG),glycosylated hemoglobin,glycosylated serum albumin,triglycerides and free fatty acids,lipid-regulating drugs,and oral antidiabetic medications were analyzed between the good(n=55)and poor(n=19)image groups,and risk factors were examined.Results The diabetes mellitus rate was higher in the poor group than in the good group(63.2%vs.33.3%,χ^(2)=4.872,P=0.027).FBG,glycosylated hemoglobin and glycosylated serum albumin levels in the poor group were increased compared with the good group[7.67(6.02,11.64)mmol/L vs.5.52(4.97,6.37)mmol/L,7.30(6.43,8.70)%vs.6.20(5.60,6.87)%,19.8(15.1,24.1)%vs.14.8(13.9,16.8)%,U=-3.909,-2.419 and-3.042,P<0.001,P=0.016 and 0.002,respectively].Multivariate Logistic regression analysis showed that FBG was an independent risk factor for poor imaging(OR=1.62,95%CI:1.19-2.20,P=0.002).The area under the receiver operator characteristic(ROC)curve for FBG was 0.811(95%CI:0.69-0.93,P<0.001),and the cut-off value for FBG was 6.66 mmol/L.Conclusions FBG is an independent risk factor for myocardial image quality.Patients with diabetes mellitus should

关 键 词：血糖 冠状动脉疾病 脱氧葡萄糖 

分 类 号：R541.4[医药卫生—心血管疾病]