门控心肌灌注显像左心室形态指数和偏心指数在评估心肌梗死患者左心室重构中的价值  

Value of left ventricular shape index and eccentricity index of gated myocardial perfusion imaging in the evaluation of left ventricular remodeling in patients with myocardial infarction

作　　者：席小依 王璐霞 姚玘 皇甫世豪 肖钰昕 武志芳[1] 武萍[1] 李莉[1] 闫蕊[1] 王跃涛[2] 杨敏福[3] 李思进[1] Xi Xiaoyi;Wang Luxia;Yao Qi;Huangfu Shihao;Xiao Yuxin;Wu Zhifang;Wu Ping;Li Li;Yan Rui;Wang Yuetao;Yang Minfu;Li Sijin(Department of Nuclear Medicine,First Hospital of Shanxi Medical University Collaborative Innovation Center of Molecular Imaging Precision Diagnosis and Treatment,Taiyuan 030001,China;Department of Nuclear Medicine,the First People′s Hospital of Changzhou,Changzhou 213003,China;Department of Nuclear Medicine,Beijing Chaoyang Hospital of Capital Medical University,Beijing 100020,China)

机构地区：[1]山西医科大学第一医院核医学科、分子影像精准诊疗省部共建协同创新中心,太原030001 [2]常州市第一人民医院核医学科,常州213003 [3]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》2024年第1期6-11,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81901785)。

摘　　要：目的探讨左心室形态指数(SI)和偏心指数(EI)对左心室重构的评估价值。方法回顾性分析2016年1月至2020年9月间于山西医科大学第一医院行门控心肌灌注显像(GMPI)且确诊心肌梗死(MI)的患者324例[男264例、女60例, 年龄(62.5±11.8)岁]和健康对照(HC)者113例[男47例、女66例, 年龄(57.8±10.7)岁]。通过定量门控SPECT (QGS)软件获得SI[舒张末期SI(EDSI)、收缩末期SI(ESSI)]、EI、左心室功能参数[舒张末期容积(EDV)、收缩末期容积(ESV)、左心室射血分数(LVEF)、室壁运动总评分(SMS)、室壁增厚总评分(STS)、高峰射血率(PER)、高峰充盈率(PFR)]。采用倾向性评分(PS)逆处理概率加权法(IPTW)平衡组间协变量。分析平衡后的MI组与HC组间SI、EI和左心室功能参数的差异及相关性。应用ROC曲线评价2组EDV、EDSI、ESSI、EI单独及联合评估左心室收缩功能受损的价值。采用两独立样本t检验、Pearson相关及Spearman秩相关分析、Delong检验等分析数据。结果 IPTW后MI组(319例)的EDSI、ESSI大于HC组(133例;EDSI:0.66±0.09和0.60±0.06;ESSI:0.59±0.11和0.47±0.07;t值:8.05、14.67, 均P<0.001), EI小于HC组(0.81±0.06和0.85±0.03;t=-8.93, P<0.001)。在MI组与HC组中, EDSI与ESSI(r值:0.928与0.873), EDSI、ESSI与EI(r值:-0.831~-0.641), EDSI、ESSI与LVEF(r值:-0.627~-0.201), ESSI与EDV、ESV、SMS(rs值:0.336~0.584), ESSI与-PER、PFR(rs值:-0.406~-0.402,r值:-0.352~-0.325)的相关性均有统计学意义(均P<0.01)。ROC曲线示MI组、HC组中对左心室收缩功能受损的评估效能最高分别为EDV(AUC:0.895)、ESSI(AUC:0.839);EDV-EDSI-ESSI-(1-EI)对左心室收缩功能受损的评估效能在MI组(AUC:0.956)高于EDV、EDV-EDSI、EDV-ESSI和EDV-(1-EI)(z值:-2.64~-2.18, P值:0.008~0.029), 在HC组(AUC:0.911)高于EDV、EDV-EDSI和EDV-(1-EI)(z值:-2.60~-2.43, P值:0.009~0.015)。结论 MI患者SI增大、EI减小提示左心室球形度增加、重构程度加重。SI、EI对评估左心室形态、预测左�Objective To investigate the clinical value of left ventricular shape index(SI)and eccentricity index(EI)in evaluating left ventricular remodeling.Methods A retrospective analysis was performed on 324 patients(264 males,60 females,age(62.5±11.8)years)diagnosed with myocardial infarction(MI)and 113 healthy controls(HC;47 males,66 females,age(57.8±10.7)years)who received gated myocardial perfusion imaging(GMPI)in First Hospital of Shanxi Medical University from January 2016 to September 2020.SI(end-diastolic SI(EDSI),end-systolic SI(ESSI)),EI and left ventricular function parameters(end-diastolic volume(EDV),end-systolic volume(ESV),left ventricular ejection fraction(LVEF),summed motion score(SMS),summed thickening score(STS),peak ejection rate(PER)and peak filling rate(PFR))were obtained by quantitative gated SPECT(QGS)software.Propensity score(PS)inverse probability of treatment weighting(IPTW)was used to balance the intergroup covariates.The differences and correlations of EDSI,ESSI,EI and left ventricular function parameters between patients in MI group and HC group were analyzed.ROC curve analysis was used to evaluate the values of EDV,EDSI,ESSI and EI alone and in combination in the assessment of left ventricular systolic function impairment.Data were analyzed by independent-sample t test,Pearson correlation and Spearman rank correlation analyses,and Delong test.Results After IPTW,EDSI and ESSI in MI group(n=319)were higher than those in HC group(n=133;EDSI:0.66±0.09 vs 0.60±0.06;ESSI:0.59±0.11 vs 0.47±0.07;t values:8.05,14.67,both P<0.001),and EI was lower than that in HC group(0.81±0.06 vs 0.85±0.03;t=-8.93,P<0.001).In both groups,there were significant correlations between EDSI and ESSI(r values:0.928,0.873),between EDSI,ESSI and EI(r values:from-0.831 to-0.641),between EDSI,ESSI and LVEF(r values:from-0.627 to-0.201),between ESSI and EDV,ESV and SMS(rs values:0.336-0.584),between ESSI and-PER,PFR(rs values:from-0.406 to-0.402,r values:from-0.352 to-0.325)(all P<0.01).ROC curve analysis showed that

关 键 词：心肌梗死 心室重构 心肌灌注显像 99M锝甲氧基异丁基异腈 

分 类 号：R542.22[医药卫生—心血管疾病] R445.2[医药卫生—内科学]