门控心肌灌注显像预测慢性肾脏病患者主要心血管不良事件  

Gated myocardial perfusion imaging for predicting major adverse cardiovascular events in chronic kidney disease patients

作　　者：张颖[1] 董薇[1] 焦建[1] 牟甜甜[1] 常智 李全[1] 李珺奇[1] 张烨虹[1] 解小芬[1] 米宏志[1] ZHANG Ying;DONG Wei;JIAO Jian;MOU Tiantian;CHANG Zhi;LI Quan;LI Junqi;ZHANG Yehong;XIE Xiaofen;MI Hongzhi(Department of Nuclear Medicine,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院核医学科,北京100029

出　　处：《中国医学影像技术》2024年第10期1499-1503,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察门控心肌灌注显像(G-MPI)相关半定量参数预测慢性肾脏病(CKD)患者主要心血管不良事件(MACE)的价值。方法回顾性纳入148例接受静息G-MPI(R-GMPI)(R-GMPI组,n=95)或负荷/静息G-MPI(S/R-GMPI)(S/R-GMPI组,n=53)检查的CKD患者,根据随访期间是否发生MACE将其分为MACE亚组与无MACE亚组;比较亚组间临床资料及G-MPI参数,采用多因素Cox比例风险回归分析获取CKD患者发生MACE的独立预测因素;绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估各独立预测因素预测MACE的效能。针对仅接受R-GMPI者以ROC曲线分析获取各参数预测MACE的最佳截断值、进行MACE风险分层并绘制Kaplan-Meier曲线,以log-rank检验进行比较。结果95例仅接受R-GMPI中,相比无MACE亚组,MACE亚组体质量指数较小而既往心肌梗死及血液透析者占比较高,左心室舒张末期容积(R-LVEDV)、收缩末期容积(R-LVESV)及静息异常总积分(R-SRS)较高而射血分数(R-LVEF)较低(P均<0.05);R-SRS[HR=1.068,95%CI(1.027,1.110)]及R-LVESV[HR=1.011,95%CI(1.005,1.017)]为此类CKD患者MACE的独立预测因素(P均<0.05)。53例接受S/R-GMPI,其中,相比无MACE亚组,MACE亚组血肌酐较高而估算肾小球滤过率(eGFR)较低,S-ESV、R-EDV、负荷异常总积分(SSS)、SRS及二者差值(SDS)均较高(P均<0.05);SDS[HR=1.454,95%CI(1.063,1.989)]为此类CKD患者MACE的独立预测因素(P<0.05)。对95例仅接受R-GMPI者,单一以R-SRS或R-LVESV预测其发生MACE的AUC分别为0.659和0.694;R-SRS≥8分者、R-LVESV≥91 ml者MACE发生率较高(P均<0.05)。结论G-MPI可用于评估CKD患者心肌灌注及功能。对仅接受R-GMPI的CKD患者,R-SRS和R-LVESV为其发生MACE的独立预测因素;而对能耐受S/R-GMPI的CKD患者,利用SDS可预测其MACE风险。Objective To observe the value of semi-quantitative parameters related to gated myocardial perfusion imaging(G-MPI)for predicting occurrence of major adverse cardiovascular events(MACE)in patients with chronic kidney disease(CKD).Methods Totally 148 CKD patients who underwent rest G-MPI(R-GMPI)(R-GMPI group,n=95)or stress/rest G-MPI(S/R-GMPI)(S/R-GMPI group,n=53)were retrospectively included.The patients were categorized into MACE subgroup and non-MACE subgroup according to MACE occurred or not during follow-up.Clinical data and G-MPI parameters were compared between subgroups,and independent predictors of MACE in CKD patients were obtained using multivariate Cox proportional hazards regression analysis.Receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated to assess the efficacy of each independent predictor for predicting MACE.Among patients who underwent only R-GMPI,the optimal cut-off value of each parameter for predicting MACE was obtained by ROC curve analysis,and the risk of MACE was stratified,then Kaplan-Meier curves were drawn and compared with log-rank test.Results Among 95 patients who underwent only R-GMPI,compared with non-MACE subgroup,those in MACE subgroup had smaller body mass index(BMI)and higher proportion of previous myocardial infarction and hemodialysis,as well as higher R-GMPI left ventricle end-diastolic volume(R-LVEDV),left ventricle end-systolic volume(R-LVESV),sum rest score(R-SRS)but lower left ventricle ejection fraction(R-LVEF)(all P<0.05),while R-SRS(HR=1.068,95%CI[1.027,1.110])and R-LVESV(HR=1.011,95%CI[1.005,1.017])were both independent predictors for MACE(both P<0.05).Among 53 patients who underwent S/R-GMPI,compared with non-MACE subgroup,those in MACE subgroup had with higher blood creatinine and lower estimated glomerular filtration rate(eGFR),higher S-LVESV,R-LVEDV,sum stress score(SSS),SRS and sum difference score(SDS)(all P<0.05),and SDS(HR=1.454,95%CI[1.063,1.989])was an independent predictor for MACE(P<0.05).Among 95 CKD patient

关 键 词：肾功能不全 慢性 心血管疾病 心肌灌注显像 

分 类 号：R692.5[医药卫生—泌尿科学] R817[医药卫生—外科学]