一日法多巴酚丁胺负荷/静息SPECT心肌灌注显像指导治疗冠心病的临床价值  

Value of dobutamine loading/resting SPECT myocardial perfusion imaging in guiding the treatment of coronary heart disease

作　　者：钟儒婷 周围 麦林琳 刘静玲 徐荣浩 ZHONG Ruting;ZHOU Wei;MAI Linlin;LIU Jingling;XU Ronghao(Department of Nuclear Medicine,Shunde Hospital,Southern Medical University,Foshan 528308,China;Department of Cardiovascular Medicine,Shunde Hospital,Southern Medical University,Foshan 528308,China)

机构地区：[1]南方医科大学顺德医院核医学科,广东佛山528308 [2]南方医科大学顺德医院心血管内科,广东佛山528308

出　　处：《分子影像学杂志》2022年第2期183-188,共6页Journal of Molecular Imaging

基　　金：佛山市医学类科技攻关项目(2018AB000913);广东省医学科研基金立项资助项目(A2016443);佛山市高层次医学人才培养(医学骨干人才)。

摘　　要：目的 研究一日法多巴酚丁胺负荷/静息单光子发射计算机断层扫描(SPECT)心肌灌注显像指导治疗冠心病的临床应用价值。方法 回顾性收集我院2019年5月~2021年7月因胸闷、胸痛就诊的冠心病患者68例,常规行冠状动脉CT血管造影(CCTA),将患者分为两组:研究组(n=34),同期行一日法多巴酚丁胺负荷/静息SPECT心肌灌注显像并依据SPECT结果选择治疗方案;对照组(n=34),依据CCTA结果选择治疗方案。确定治疗方案后随诊,比较两组症状缓解率及心血管不良事件发生率,分析SPECT及CCTA推荐的治疗方案差异及原因。结果 两组间临床病情、冠脉狭窄程度、病变部位及数量差异无统计学意义(P>0.05)。研究组中血运重建治疗3%(1/34),单纯药物治疗97%(33/34),症状缓解率100%;对照组中血运重建治疗50%(17/34),单纯药物治疗50%(17/34),症状缓解率100%。研究组血运重建率低于对照组(χ^(2)=19.342,P<0.05)。随诊7~33月(中位数28月),心血管不良事件发生率对照组3%(1/34),研究组为0。研究组有14例患者SPECT的治疗建议与CCTA的治疗建议不同,最终这14例患者均依据SPECT结果选择了单纯药物治疗,比依据CCTA结果做决策的冠脉造影率减少约41%(14/34),单次住院诊疗费用节省约50%。结论 一日法多巴酚丁胺负荷/静息SPECT心肌灌注显像有利于筛选出不需介入治疗的冠心病患者,其采用单纯药物治疗方案安全有效,相较于目前常用的CCTA筛查,可减少不必要的有创检查及介入手术,降低医疗总费用,缩短住院时间。Objective To investigate the clinical application value of one-day dobutamine loading/resting single-photon emission computed tomography(SPECT) myocardial perfusion imaging in guiding the treatment of coronary heart disease.Methods A retrospective collection of 68 patients with coronary heart disease who presented to our hospital with chest tightness and chest pain in our hospital from May 2019 to July 2021, routinely underwent coronary computed tomography angiography(CCTA), 34 of them underwent one-day dobutamine loading/resting SPECT myocardial perfusion imaging at the same time, and the therapy was selected based on SPECT results as the study group. The other 34 cases selected the therapy based on CCTA results as the control group. After determining the treatment regimen, the two groups were followed up to compare the rates of symptom relief and cardiovascular adverse events, and to analyse the differences between the treatment regimens recommended by SPECT and CCTA and the reasons for them. Results There were no significant differences in clinical condition and the stenosis degree, lesion location and number of coronary artery between the two groups(P>0.05). In the study group, the patient who was treated with revascularization method accounted for 3%(1/34), the remaining patients treated with drugs alone accounted for 97%(33/34), and the symptom remission rate was 100%. In the control group, those patients which were treated by revascularization method accounted for 50%(17/34),the remaining patients which were treated with drugs alone accounted for 50%(17/34), and the symptom remission rate was 100%. The revascularization rate of the study group was lower than that of the control group(χ^(2)=19.342,P<0.05). At 7-33 months follow-up(median 28 months), the incidence of adverse cardiovascular events was 3% in the control group(1/34) and 0 in the study group. 14 patients in the study group had treatment recommendations for SPECT that differed from those for CCTA. In the end, these 14 patients chose drug therapy

关 键 词：负荷/静息SPECT心肌灌注显像 冠心病 冠状动脉CT血管造影 治疗 多巴酚丁胺 

分 类 号：R541.4[医药卫生—心血管疾病]