影响心肌血流下降的因素及其价值研究  

Factors influencing myocardial blood flow decline and their value study

作　　者：蔡文怡 方章 施建伷 卜菊 陈丽梅 赵中强[1] 周宁天[1] 李殿富[1] CAI Wenyi;FANG Zhang;SHI Jianzhou;BU Ju;CHEN Limei;ZHAO Zhongqiang;ZHOU Ningtian;LI Dianfu(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu,China;Department of Cardiology,Taikang Xianlin Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210046,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,南京210029 [2]南京大学医学院附属泰康仙林鼓楼医院心血管内科,南京210046

出　　处：《医学研究与战创伤救治》2024年第3期287-291,共5页Journal of Medical Research & Combat Trauma Care

摘　　要：目的探讨传统单光子发射计算机断层成像(SPECT)获取的心肌灌注显像、半定量参数以及冠脉造影结果、临床参数对心肌缺血的影响。方法回顾性分析2022年6月至2022年10月在南京医科大学第一附属医院(江苏省人民医院)完成CZT-SPECT检查的116例临床疑似或确诊的冠心病患者临床资料,最终纳入39例患者。以三支主要冠脉区域心肌血流储备功能<2.1作为心肌缺血的诊断标准,绘制冠脉狭窄程度、区域负荷灌注积分(SS)、静息灌注积分(RS)和灌注积分差(DS)诊断心肌缺血的ROC曲线以获得最佳截断值和相应的诊断效能,通过逐步回归法建立预测模型,绘制ROC曲线。结果共计117支主要血管,其中判定为心肌缺血的有36支(30.77%)。冠脉狭窄程度、SS、RS和DS诊断心肌缺血的ROC曲线最佳截断值分别为53%、3.5、1.5、1.5,准确性分别为75.2%、74.4%、70.9%、72.6%,ROC曲线的AUC及95%CI分别为0.78(0.68~0.87)、0.64(0.53~0.74)、0.58(0.49~0.66)、0.65(0.55~0.75)。冠脉狭窄程度、血管区域心肌灌注显像、SS、RS和DS等单因素有意义的指标联合预测心肌缺血的ROC曲线的AUC及95%CI为0.79(0.69~0.88)。逐步回归法踢除变量后,最终模型预测心肌缺血的ROC曲线的AUC及95%CI为0.84(0.76~0.92)。结论SPECT心肌灌注显像中SS>3.5、DS>1.5、RS>1.5对预测心肌缺血有一定的意义,联合多个指标(冠脉造影结果、SS、DS、RS、心肌灌注显像)预测显著提高了对心肌缺血的诊断价值。Objective This study aimed to investigate the impact of myocardial perfusion imaging(MPI),semi-quantitative parameters obtained through traditional single-photon emission computed tomography(SPECT),coronary angiography results and clinical parameters on myocardial ischemia.Methods Patients with coronary artery disease who underwent simultaneous cadmium zinc telluride SPECT(CZT SPECT)and coronary angiography(CAG)examinations were enrolled.Myocardial ischemia was diagnosed based on coronary flow reserve(CFR)<2.1 in the territory of any of the three major coronary arteries.Receiver operating characteristic(ROC)curves were generated for coronary stenosis severity,summed stress score(SS),rest score(RS),and score difference(DS)to determine the optimal cutoff values and corresponding diagnostic performance for myocardial ischemia.A predictive model was established using stepwise regression,and ROC curves were plotted.Results The final cohort included 39 patients with a total of 117 major vessels,of which 36 vessels(30.77%)were determined to have myocardial ischemia.The optimal cutoff values for coronary stenosis severity,SS,RS,and DS in diagnosing myocardial ischemia were 53%,3.5,1.5,and 1.5,respectively.The accuracies were 75.2%,74.4%,70.9%,and 72.6%,respectively.The area under the curve(AUC)and 95%confidence intervals(CI)were 0.78(0.68-0.87),0.64(0.53-0.74),0.58(0.49-0.66),and 0.65(0.55-0.75),respectively.The AUC and 95%CI of the predictive model established using stepwise regression were 0.84(0.76-0.92).Conclusion In traditional SPECT MPI,SS>3.5,DS>1.5,RS>1.5 hold certain significance in predicting myocardial ischemia.Combining angiographic results with SS,a history of hypertension and smoking habits enhance the accuracy of predicting myocardial ischemia.

关 键 词：冠心病 冠状动脉血流储备 碲锌镉 单光子发射计算机断层成像 心肌灌注显像 

分 类 号：R541.4[医药卫生—心血管疾病]