腺苷负荷^(99)Tc^(m)-MIBI SPECT评价尼可地尔对冠脉微血管心绞痛疗效的价值  

The value of adenosine loading ^(99)Tc_(m)-MIBI SPECT in evaluating the therapeutic effect of nicorandil on coronary microvascular angina pectoris

作　　者：汤楠 于博 王丹 范晓丹 尹楠楠 祁春梅 Tang Nan;Yu Bo;Wang Dan;Fan Xiaodan;Yin Nannan;Qi Chunmei(Department of Cardiovascular Medicine,the Second Affliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;Department of Pharmacy,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学第二附属医院心内科,徐州221000 [2]徐州医科大学第二附属医院药剂科,徐州221000

出　　处：《中国医师杂志》2024年第7期1035-1041,共7页Journal of Chinese Physician

基　　金：江苏省卫生健康委科研课题(H2018002);徐州市卫健委科研项目(XWYXKY202110)。

摘　　要：目的探讨腺苷负荷^(99)Tc^(m)-MIBI单光子发射计算机断层显像(SPECT)评价尼可地尔对冠脉微血管心绞痛(CMVA)疗效的价值。方法选取徐州医科大学第二附属医院2021年1月至2022年3月临床诊断为CMVA患者68例,依据随机数字表法将其分为对照组和尼可地尔组,每组34例。对照组在常规治疗的基础上给予单硝酸异山梨酯,尼可地尔组在常规治疗的基础上加用尼可地尔,两组均连续治疗3个月。所有患者在治疗前后分别进行腺苷负荷^(99)Tc^(m)-MIBI SPECT检查,测量心肌灌注缺损程度(SDS)、心肌灌注缺损面积(SRS)和心肌灌注缺损改善程度(SIS),并评估临床症状、心电图变化、心肌酶学指标[肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]、血流动力学参数[收缩压(SBP)、舒张压(DBP)、心率(HR)、每搏输出量(SV)、心排血量(CO)、外周阻力(TPR)、左室做功指数(LVWI)和心肌耗氧量(MVO_(2))]等。结果治疗后,尼可地尔组的SDS、SRS均显著低于对照组(均P<0.01),SIS显著高于对照组(P<0.01);心肌灌注异常显像的改善明显优于对照组(χ^(2)=4.976,P<0.05);心绞痛发作频率、持续时间和程度,加拿大心脏协会(CCS)分级、心电图缺血性改变的发生率均低于对照组(均P<0.01);血清cTnI、CK-MB、LDH水平均显著低于对照组(均P<0.01);SBP、DBP、HR、LVWI、MVO_(2)均显著低于对照组(均P<0.01),SV、CO均显著高于对照组(均P<0.01)。结论腺苷负荷^(99)Tc_(m)-MIBI SPECT能够有效评价尼可地尔对CMVA的疗效,尼可地尔能够改善CMVA患者的心肌灌注缺损和临床表现。Objective To explore the value of adenosine loaded ^(99)Tc_(m)-MIBI single photon emission computed tomography(SPECT)in evaluating the therapeutic effect of nicorandil on coronary microvascular angina(CMVA).Methods Sixty eight patients diagnosed with CMVA in the Second Affiliated Hospital of Xuzhou Medical University from January 2021 to March 2022 were selected and randomly divided into a control group and a nicorandil group,with 34 patients in each group,using a random number table method.The control group received isosorbide mononitrate in addition to conventional treatment,while the nicorandil group received nicorandil in addition to conventional treatment.Both groups were treated continuously for 3 months.All patients underwent adenosine loading99Tcm-MIBI SPECT before and after treatment to measure the degree of myocardial perfusion defect(SDS),myocardial perfusion defect area(SRS),and degree of improvement of myocardial perfusion defect(SIS).Clinical symptoms,electrocardiogram changes,myocardial enzyme indicators[cardiac troponin I(cTnI),creatine kinase-MB(CK-MB),lactate dehydrogenase(LDH)],hemodynamic parameters[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),stroke volume(SV),cardiac output(CO),peripheral resistance(TPR),left ventricular work index(LVWI),and myocardial oxygen consumption(MVO_(2))]were evaluated.Results After treatment,the SDS and SRS of the nicorandil group were significantly lower than those of the control group(P<0.01),and the SIS was significantly higher than that of the control group(all P<0.01);The improvement of abnormal myocardial perfusion imaging was significantly beter than that of the control group(χ^(2)=4.976,P<0.05);the frequency,duration,and severity of angina attacks,Canadian Heart Association(CCS)grading,and incidence of ischemic changes on electrocardiogram were all lower than those of the control group(P<0.01);The levels of serum cTnI,CK-MB,and LDH were significantly lower than those in the control group(all P<0.01);SBP,DBP,HR,LVWI,and MVO_(2)

关 键 词：单光子发射计算机体层摄影术 99M锝甲氧基异丁基异腈 尼可地尔 冠脉微血管心绞痛 

分 类 号：R541.4[医药卫生—心血管疾病]