动态单光子发射计算机断层成像检测冠状动脉血流储备评估心力衰竭患者冠状动脉微循环功能的价值  

The clinical value of coronary flow reserve via dynamic single photon emission computed tomography in evaluating coronary microcirculation function in patients with heart failure

作　　者：宋昱 崔晓通 徐亚妹 周京敏 葛均波 Song Yu;Cui Xiaotong;Xu Yamei;Zhou Jingmin;Ge Junbo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科,上海200032

出　　处：《中国医师进修杂志》2024年第9期785-790,共6页Chinese Journal of Postgraduates of Medicine

基　　金：国家重点研发计划(2018YFE0103000);国家自然科学基金(82200423)。

摘　　要：目的探讨动态单光子发射计算机断层成像(D-SPECT)检测冠状动脉血流储备(CFR)评估心力衰竭患者冠状动脉微循环障碍(CMD)的价值。方法采用前瞻性研究的方法,选取2019年9月至2020年9月复旦大学附属中山医院心力衰竭患者194例,均采用D-SPECT检测CFR,将CFR<2定义为CMD。记录一般资料,包括年龄、性别、体质量指数(BMI)、血压、心率、吸烟史、纽约心脏病协会(NYHA)心功能分级、合并症和用药情况。记录实验室检查结果,包括血尿素氮、血肌酐、血尿酸、估算肾小球滤过率(eGFR)、高敏C反应蛋白(hs-CRP)、心肌肌钙蛋白T(cTnT)和氨基末端利钠肽前体(NT-proBNP)。采用心脏超声检测左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVST)、肺动脉收缩压(PASP)和左心室射血分数(LVEF)。患者出院后采用门诊或电话随访,随访的主要终点为心血管死亡和心力衰竭再入院组成的复合终点。多元线性回归分析影响CFR的危险因素;绘制Kaplan-Meier生存曲线,采用log-rank检验评估CFR对患者预后的影响。结果194例患者中,合并CMD 133例(CMD组),CMD发生率为68.56%;未合并CMD 61例(非CMD组)。两组性别构成、BMI、吸烟史比例、血压、心率、高血压率、心房颤动率、糖尿病率、肾功能不全率、用药情况、LAD、LVEDD、IVST、PASP、血尿素氮、血肌酐、血尿酸、eGFR和hs-CRP比较差异无统计学意义(P>0.05);CMD组年龄、NYHA心功能分级Ⅲ~Ⅳ级率、心肌梗死或血运重建史率、LVESD、cTnT和NT-proBNP明显高于非CMD组[(60.7±14.0)岁比(55.9±15.8)岁、54.89%(73/133)比26.23%(16/61)、22.56%(30/133)比1.64%(1/61)、(48.8±13.1)mm比(44.6±11.4)mm、0.023(0.015,0.046)μg/L比0.015(0.010,0.023)μg/L和1591(751,3409)ng/L比1132(288,1860)ng/L],LVEF明显低于非CMD组[(40.9±14.2)%比(45.5±14.1)%],差异有统计学意义(P<0.05或<0.01)。多元线性回归分析结果显示,cTnT�Objective To study the value of coronary flow reserve(CFR)via dynamic single photon emission computed tomography(D-SPECT)in evaluating coronary microcirculation dysfunction(CMD)in patients with heart failure.Methods A prospective research method was adopted.One hundred and ninety-four patients with heart failure from September 2019 to September 2020 in Zhongshan Hospital,Fudan University were selected.The patients were tested for CFR using D-SPECT,and CFR<2 was defined as CMD.The general data were recorded,including age,gender,body mass index(BMI),blood pressure,heart rate,smoking history,New York Heart Association(NYHA)heart function classification,comorbidities and medication situation.The laboratory test results were recorded,including blood urea nitrogen,blood creatinine,blood uric acid,estimated glomerular filtration rate(eGFR),high-sensitivity C-reactive protein(hs-CRP),cardiac troponin T(cTnT)and N terminal pro B type natriuretic peptide(NT-proBNP).The left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),interventricular septal thickness(IVST),pulmonary artery systolic pressure(PASP)and left ventricular ejection fraction(LVEF)were measured by cardiac ultrasound.After discharge,patients were followed up in outpatient or telephone contact,with the primary endpoint event being a composite endpoint consisting of cardiovascular death and heart failure readmission.Multiple linear regression analysis was used to analyze the risk factors of CFR.The Kaplan-Meier survival curve was draw,and the log-rank test was used to evaluate the effect of CFR on prognosis.Results Among 194 patients,133 patients had CMD(CMD group),and the incidence of CMD was 68.56%;61 patients did not have CMD(non-CMD group).There were no statistical differences in gender composition,BMI,smoking history proportion,blood pressure,heart rate,hypertension rate,atrial fibrillation rate,diabetes mellitus rate,renal dysfunction rate,medication situation,LAD,LVEDD,IVST,PASP,blood urea ni

关 键 词：心力衰竭 单光子发射计算机体层摄影术 微循环 冠状动脉血流储备 

分 类 号：R541.6[医药卫生—心血管疾病] R816.2[医药卫生—内科学]