^(18)F-FDG PET/CT炎症显像评价急性心肌梗死患者左心功能的预后价值  

Prognostic value of ^(18)F-FDG PET/CT imaging of inflammation in evaluating left ventricle function in patients with acute myocardial infarction

作　　者：温庆祥[1] 席笑迎 姚丹丹 杨敏福[2] Wen Qingxiang;Xi Xiaoying;Yao Dandan;Yang Minfu(Department of Nuclear Medicine,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Nuclear Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京中医医院核医学科,北京100010 [2]首都医科大学附属北京朝阳医院核医学科,北京100020

出　　处：《中华核医学与分子影像杂志》2022年第8期452-456,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：北京市医院管理中心"扬帆"计划重点医学专业(ZYLX202105)。

摘　　要：目的探讨^(18)F-FDG PET/CT心肌炎症显像对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后左心功能的预后价值。方法前瞻性纳入2016年1月至2016年12月在北京朝阳医院首次行PCI的急性ST段抬高型心肌梗死(STEMI)患者31例[男26例、女5例,年龄(55.4±10.1)岁]。所有患者在PCI术后第5天行一日法99Tcm-甲氧基异丁基异腈(MIBI)静息心肌灌注显像(MPI)及^(18)F-FDG PET/CT显像。采用指南推荐的方法抑制心肌的^(18)F-FDG生理性摄取。测定梗死区、偏远区SUVmax及上腔静脉SUVmean,计算梗死区、偏远区的靶本比(TBR)。获取左心室^(18)F-FDG摄取容积(Vol-FDG)、^(18)F-FDG摄取范围占左心室百分比(F/LV%)、心肌灌注缺损范围占左心室百分比(def/LV%)。根据基线及AMI后6个月左心室射血分数(EF)获得EF变化率(ΔEF),比较左心功能改善组(ΔEF≥10%)和未改善组(ΔEF<10%)患者相关指标。采用两独立样本t检验(或Mann-WhitneyU检验)和Pearson相关(或Spearman秩相关)分析数据。结果患者心肌梗死区TBR高于偏远区(2.8±1.0与1.1±0.3;t=11.03,P<0.001);F/LV%明显大于def/LV%[33.7%(25.8%,43.3%)与8.8%(2.3%,20.7%);z=-4.72,P<0.001]。梗死区及偏远区TBR均与外周血单核细胞计数呈正相关(r=0.44,P=0.014;r=0.37,P=0.042);Vol-FDG与心肌损伤标志物[肌酸激酶(CK)、CK同工酶(CK-MB)、肌钙蛋白I(cTnI)]均呈正相关(r值:0.46、0.41和0.68,均P<0.05)。31例患者中,26例(83.9%)完成6个月的心功能随访;未改善组(11例)的Vol-FDG明显大于改善组[15例;(104.5±47.2)与(70.1±26.3)cm3;t=2.38,P=0.026],且Vol-FDG与ΔEF呈负相关(rs=-0.41,P=0.038)。结论^(18)F-FDG PET/CT显像能有效评价PCI后AMI患者心肌炎性反应的强度及范围,并能评估患者左心功能预后。Objective To investigate the value of ^(18)F-FDG PET/CT myocardial inflammation imaging in evaluating the functional prognosis of left ventricle(LV)in patients with acute myocardial infarction(AMI)undergoing primary percutaneous coronary intervention(PCI).Methods Thirty-one patients(26 males,5 females,age:(55.4±10.1)years)with acute ST-elevation myocardial infarction(STEMI)referred for PCI in Beijing Chaoyang Hospital between January 2016 and December 2016 were prospectively included.All patients underwent ^(18)F-FDG PET/CT following 99Tcm-methoxyisobutylisonitrile(MIBI)rest myocardial perfusion imaging(MPI)on the fifth day after PCI.A comprehensive strategy recommended by guideline was followed to suppress myocardial uptake.^(18)F-FDG uptake in infarcted and remote myocardium were quantitatively analyzed by measuring SUVmax,and that in superior vena cava was quantitatively analyzed by measuring SUVmean.Target-to-background ratios(TBRs)in infarcted and remote area were calculated.In addition,the following parameters were obtained:^(18)F-FDG uptake volume of LV(Vol-FDG),percentage of ^(18)F-FDG uptake size of LV(F/LV%),percentage of myocardial perfusion defect size of LV(def/LV%).According to the left ventricular ejection fraction(EF)at baseline and 6 months after AMI,the changing rate of EF(ΔEF)was calculated,and data of patients in improvement group(ΔEF≥10%)and no improvement group(ΔEF<10%)were compared.Independent-sample t test or Mann-Whitney U test,and Pearson correlation analysis or Spearman rank correlation analysis were used for data analysis.Results TBR was significantly higher in infarcted myocardium than that in remote area(2.8±1.0 vs 1.1±0.3;t=11.03,P<0.001).F/LV%was greater than def/LV%(33.7%(25.8%,43.3%)vs 8.8%(2.3%,20.7%);z=-4.72,P<0.001).TBR in both infarcted and remote areas showed positive correlations with peripheral blood monocyte counts(r=0.44,P=0.014;r=0.37,P=0.042).Vol-FDG had positive correlations with the myocardial injury markers(creatine kinase(CK),CK isoenzyme(CK-MB),cardiac tro

关 键 词：心肌梗死 心室功能 左 炎症 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

分 类 号：R542.22[医药卫生—心血管疾病] R817.4[医药卫生—内科学]