碲锌镉心脏专用SPECT对PCI术后造影阴性胸痛患者冠状动脉微血管功能障碍的诊断价值  

Diagnostic value of cadmium-zinc-telluride SPECT for coronary microvascular dysfunction in patients with negative coronary angiography after percutaneous coronary intervention

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

机构地区：[1]天津医科大学心血管病临床学院,泰达国际心血管病医院,天津300457

出　　处：《医疗卫生装备》2022年第6期54-58,共5页Chinese Medical Equipment Journal

基　　金：泰达国际心血管病医院课题(2021-TD-003)。

摘　　要：目的:探讨碲锌镉(cadmium-zinc-telluride,CZT)心脏专用SPECT(CZT-SPECT)心肌血流定量显像对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后冠状动脉造影(coronary angiography,CAG)阴性胸痛患者冠状动脉微血管功能障碍(coronary microvascular dysfunction,CMD)的诊断价值。方法:回顾性收集2018年12月至2021年7月于某院进行CZT-SPECT心肌血流定量显像的PCI术后患者384例,筛选显像前后3个月内CAG结果阴性的胸痛患者共64例,以左心室心肌血流储备(left ventricle myocardial flow reserve,LV-MFR)值为2.0作为诊断界值将纳入病例分为CMD组(n=33)和非CMD组(n=31),采用独立样本t检验、Mann-Whitney U检验或皮尔逊卡方检验分析2组在临床基线资料、血脂生化指标、定量血流参数和半定量血流参数方面的差异。结果:与非CMD组相比,CMD组的左心室负荷心肌血流(stress myocardial blood flow,sMBF)明显减低(P<0.05),而2组间左心室静息心肌血流(rest myocardial blood flow,r MBF)无明显差异;2组间的临床基线资料(高血压病史、高脂血症病史、胸痛症状病史、糖尿病病史、冠心病家族病史、吸烟史、饮酒史、年龄、性别、身体质量指数、PCI治疗血管支数)、血脂生化指标(总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇)、半定量血流参数[负荷灌注减低范围(负荷Extent)、静息灌注减低范围(静息Extent)、累积负荷评分、累积静息评分、累积差值评分]的差异均无统计学意义(P均>0.05)。结论:CZT-SPECT心肌血流定量显像为PCI术后CAG阴性胸痛患者CMD的诊断和评价提供了一种客观的影像学方法,具有一定的临床应用价值。Objective To explore the value of myocardial blood flow quantitation by cadmium-zinc-telluride SPECT(CZT-SPECT)for the diagnosis of coronary microvascular dysfunction(CMD)in patients with negative coronary angiography(CAG)after percutaneous coronary intervention(PCI).Methds A total of 384 post-PCI patients who underwent myocardial blood flow quantitation with CZT-SPECT at some hospital from December 2018 to July 2021 were retrospectively collected,among whom 64 patients with chest pain and negative CAG within 3 months before and after quantitation were finally included in this study.The diagnostic threshold was set as the left ventricle myocardial flow reserve(MFR)being 2 to divide the included cases into a CMD group(n=33)and a non-CMD group(n=31).The differences between the 2 groups in terms of clinical baseline data,biochemical indicators for blood lipid,quantitative and semi-quantitative blood flow parameters were analyzed using independent samples t-test,Mann-Whitney U test or Pearson chi-square test.Results The CMD group had the value of stress myocardial blood flow significantly lower than that of the non-CMD group(P<0.05),while the two groups had no statistical differences in clinical baseline data(including histories of hypertension,hyperlipidemia,chest pain symptoms,diabetes,smoking and alcohol intake,family history of coronary disease,age,gender,body mass index and number of vascular branches treated with PCI),biochemical indicators for blood lipid(total cholesterol,triglycerides,HDL cholesterol and LDL cholesterol),semi-quantitative blood flow parameters(stress-Extent,rest-Extent,summed stress score,summed rest score and summed difference score)(all P>0.05).Conclusion Myocardial blood flow quantitation with CZT-SPECT provides an objective approach in diagnosing and evaluating post-PCI patients with chest pain and negative CAG,which shows specificapplication value in the clinical practice.[Chinese Medical Equipment Journal,2022,43(6):54-58]

关 键 词：碲锌镉 SPECT 经皮冠状动脉介入治疗 冠状动脉微血管功能障碍 心肌血流储备 

分 类 号：R318[医药卫生—生物医学工程] R445[医药卫生—基础医学]