SPECT心肌灌注显像及冠状动脉血流储备联合钙化积分诊断阻塞性冠心病的价值  

Value of SPECT myocardial perfusion imaging and coronary flow reserve combined with coronary artery calcium score in the diagnosis of obstructive coronary artery disease

作　　者：孙璐冰 张杰 张莹 杨柳 李耀臻 李培 郭元琨 吴文静 谢建 崔静 Sun Lubing;Zhang Jie;Zhang Ying;Yang Liu;Li Yaozhen;Li Pei;Guo Yuankun;Wu Wenjing;Xie Jian;Cui Jing(Department of Nuclear Medicine,Fuwai Central China Cardiovascular Hospital Department of Nuclear Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]阜外华中心血管病医院核医学科,河南省人民医院核医学科,郑州450003

出　　处：《中华核医学与分子影像杂志》2023年第5期272-276,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的研究SPECT心肌灌注显像(MPI)及冠状动脉血流储备(CFR)联合冠状动脉钙化积分(CACS)在阻塞性冠状动脉粥样硬化性心脏病(简称冠心病)诊断中的价值。方法回顾性分析2019年1月至2020年12月期间在阜外华中心血管病医院完成静息/负荷MPI、CFR测定及CACS检查的疑诊或确诊冠心病患者96例(男65例、女31例, 年龄30~81岁), 以冠状动脉造影(CAG)为诊断标准, 计算MPI、CFR及其联合CACS诊断冠心病的灵敏度及准确性, 采用χ^(2)检验比较诊断效能。结果 MPI诊断的灵敏度为76.06%(54/71), 准确性为75.00%(72/96), 联合CACS后灵敏度提高至97.18%(69/71;χ^(2)=13.67, P<0.001), 准确性提高至87.50%(84/96;χ^(2)=4.92, P=0.020), 差异有统计学意义;CFR诊断冠心病的灵敏度为91.55%(65/71), 准确性为87.50%(84/96), 联合CACS后分别提高至97.18%(69/71;χ^(2)=2.12, P=0.137)、89.58%(86/96;χ^(2)=0.21, P=0.411), 差异均无统计学意义。MPI诊断三支病变冠心病的灵敏度为70.00%(21/30), 联合CACS后提高至100%(30/30;χ^(2)=7.75, P=0.004), 差异有统计学意义;但MPI联合CACS诊断单支及双支病变的灵敏度无明显提高(χ^(2)值:3.29、1.51, P值:0.114、0.416)。结论 MPI联合CACS可以显著提高对三支病变患者的诊断灵敏度, 从而提高MPI对冠心病的诊断效能;但CFR联合CACS后对冠心病的诊断效能无明显提高。Objective To study the value of myocardial perfusion imaging(MPI)and coronary flow reserve(CFR)combined with coronary artery calcium score(CACS)in the diagnosis of obstructive coronary artery disease(CAD).Methods From January 2019 to December 2020,96 confirmed or suspective CAD patients(65 males,31 females;age:30-81 years)who completed rest/stress MPI,CFR and CACS defection in Fuwai Central China Cardiovascular Hospital were retrospectively analyzed.Coronary angiography(CAG)was used as the diagnostic standard to calculate the sensitivity and accuracy of MPI,CFR and MPI/CFR combined with CACS in the diagnosis of CAD.Theχ^(2) test was used to compare the diagnostic efficiency of different methods.Results The diagnostic sensitivity of MPI was 76.06%(54/71),and the accuracy was 75.00%(72/96),while the sensitivity increased to 97.18%(69/71;χ^(2)=13.67,P<0.001)and the accuracy increased to 87.50%(84/96;χ^(2)=4.92,P=0.020)with significant differences after combined with CACS.The sensitivity and accuracy of CFR were 91.55%(65/71)and 87.50%(84/96),which increased to 97.18%(69/71;χ^(2)=2.12,P=0.137)and 89.58%(86/96;χ^(2)=0.21,P=0.411)with no significant differences after combined with CACS.The sensitivity of MPI in the diagnosis of three-vessel CAD was 70.00%(21/30),which increased to 100%(30/30;χ^(2)=7.75,P=0.004)after combined with CACS;while the sensitivity of MPI combined with CACS in the diagnosis of single-vessel and double-vessel CAD were not significantly improved(χ^(2) values:3.29,1.51,P values:0.114,0.416).Conclusion The combination of MPI and CACS can significantly improve the diagnostic efficiency of CAD,contributed by the improvement of the diagnostic sensitivity in three-vessel disease;whereas the diagnostic efficiency of CFR for CAD is not significantly improved after combined with CACS.

关 键 词：冠心病 心肌灌注显像 血流储备分数 心肌 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 99M锝甲氧基异丁基异腈 冠状血管造影术 

分 类 号：R541.4[医药卫生—心血管疾病] R817.4[医药卫生—内科学]