单电子发射计算机断层成像技术在经皮冠状动脉支架植入术后患者冠脉微循环障碍中的诊断性能研究  

Diagnostic Performance of SPECT in Patients with Coronary Microcirculation Disturbance after PCI

作　　者：贾硕 程功[2] 关蕾 冯盼盼 许百灵 方伟 张骥 JIA Shuo;CHENG Gong;GUAN Lei;FENG Panpan;XU Bailing;FANG Wei;ZHANG Ji(Department of Emergency Internal Medicine,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Cardiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Ultrasound,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of General Practice,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Nuclear Science and Engineering Ins.,University of Missouri-Columbia,Columbia 65211,USA;Fuwai Hospital Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]陕西省人民医院急诊内科,陕西省西安市710068 [2]陕西省人民医院心血管内科,陕西省西安市710068 [3]陕西省人民医院超声科,陕西省西安市710068 [4]陕西省人民医院全科医学科,陕西省西安市710068 [5]美国密苏里哥伦比亚大学核科学暨工程研究所,美国哥伦比亚65211 [6]中国医学科学院阜外医院,北京市100037

出　　处：《中国全科医学》2025年第9期1122-1127,共6页Chinese General Practice

基　　金：陕西省自然科学基础研究计划项目(2022JQ-891);陕西省中医药管理局项目(2021-ZZ-ZY003);陕西省人民医院科技创新领军人才项目(2022LJ-04);陕西省人民医院孵化基金项目(2021YJY-17)。

摘　　要：背景经皮冠状动脉支架植入术(PCI)后的患者仍存在典型心绞痛症状的原因可能与合并冠脉微循环障碍(CMD)有关,单电子发射计算机断层成像技术(SPECT)作为可定量检测CMD患者冠状动脉血流储备(CFR)的一项无创检测手段,在此类人群中的诊断性能研究较少。目的评估使用升级采集技术及新的心肌血流定量分析软件后的SPECT在PCI后合并CMD患者的诊断性能。方法纳入2020年11月—2021年11月于陕西省人民医院因冠心病行PCI后仍存在典型心绞痛症状的住院患者32例为研究对象。收集患者的一般资料。行冠状动脉造影术,通过温度/压力导丝测算血流储备分数(FFR)和冠状动脉微循环阻力指数(IMR),筛选出FFR>0.8且术后无心外膜下血管梗阻性狭窄的患者共20例,共60条血管纳入研究。采用Pearson相关性分析探究IMR与CFR的相关性。以IMR为金标准,绘制CFR诊断CMD的受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC)。结果20例CMD患者纳入研究,男15例,女5例,患者平均年龄(64.2±9.3)岁。纳入的60条血管中有21条为左前降支,17条为左冠状动脉回旋支,22条为右冠状动脉。Pearson相关性分析结果显示,IMR与CFR呈负相关(r=-0.526,P<0.001)。CFR诊断CMD的AUC为0.840(95%CI=0.716~0.964),截断值为1.985。结论SPECT在PCI后患者中表现出良好的诊断性能,使用升级采集技术及新的心肌血流定量分析软件后的SPECT可作为诊断PCI后无心外膜下血管梗阻性狭窄患者是否存在CMD的有效工具。Background Patients after percutaneous coronary intervention(PCI)may still experience typical angina,potentially due to concomitant coronary microcirculation disturbance(CMD).Single-photon emission computed tomography(SPECT)serves as a non-invasive method for quantitatively assessing coronary flow reserve(CFR)in CMD patients.However,research on its diagnostic performance in this population is limited.Objective To evaluate the diagnostic performance of SPECT in patients with CMD after PCI by using upgraded acquisition techniques and novel myocardial blood flow quantitative analysis software.Methods A total of 32 patients who still had typical angina symptoms after PCI for coronary artery disease in Shaanxi Provincial People's Hospital between November 2020 and November 2021 were included in the study.General data of the patients were collected.Coronary angiography was performed,the fractional flow reserve(FFR)and index of microcirculatory resistance(IMR)were measured using a temperature/pressure guidewire,and patients with FFR>0.8 and no pericardial subvascular obstructive stenosis postoperatively were selected,encompassing 60 vessels in total.Pearson's test was used to explore the correlation between IMR and CFR.With IMR as the gold standard,a receiver operating characteristic(ROC)curve was plotted for CFR in diagnosing CMD,and the area under the ROC curve(AUC)was calculated.Results Twenty CMD patients were included in the study,comprising 15 males and 5 females,with an average age of(64.2±9.3)years.Of the 60 vessels included,21 were left anterior descending,17 were left circumflex,and 22 were right coronary arteries.Pearson's test showed a negative correlation between IMR and CFR(r=-0.526,P<0.001).The AUC for CFR in diagnosing CMD was 0.840(95%CI=0.716-0.964),the truncation value is 1.985.Conclusion SPECT has demonstrated good diagnostic performance in patients after PCI.Upgraded acquisition techniques and novel myocardial blood flow quantitative analysis software make SPECT an effective tool for diagnosing the

关 键 词：冠心病 冠脉微循环障碍 经皮腔内冠状动脉成形术 单电子发射计算机断层成像技术 临床诊断价值 

分 类 号：R541.4[医药卫生—心血管疾病]