^(18)F-NaF PET/CT冠状动脉斑块显像预测冠心病患者预后的价值  

Prognostic value of 18F-NaF PET/CT coronary plaque imaging in patients with coronary heart disease

作　　者：宇雪 李莉[1] 靳春荣[2] 洪钰 宋佳林 王波 王慧峰[3] 司新成[4] 师晓丽[1] 武志芳[1] 李思进[1] Yu Xue;Li Li;Jin Chunrong;Hong Yu;Song Jialin;Wang Bo;Wang Huifeng;Si Xincheng;Shi Xiaoli;Wu Zhifang;Li Sijin(Department of Nuclear Medicine,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Cardiology,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Cardiology,Taigang General Hospital Affiliated to Shanxi Medical University,Taiyuan 030008,China;Department of Cardiology,Linfen Fourth People′s Hospital,Linfen 041000,China)

机构地区：[1]山西医科大学第一医院核医学科,太原030001 [2]山西医科大学第一医院心内科,太原030001 [3]山西医科大学附属太钢总医院心内科,太原030008 [4]临汾市第四人民医院心内科,临汾041000

出　　处：《中华核医学与分子影像杂志》2025年第2期65-70,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(U22A6008)。

摘　　要：目的探讨18F-NaF PET/CT冠状动脉斑块显像评估冠状动脉粥样硬化性心脏病(CAD)患者长期预后的临床价值。方法选取2015年9月至2022年10月多中心临床已确诊的54例CAD患者[男37例,女17例,年龄(57.2±9.8)岁]进行回顾性队列研究。患者在1周内完成18F-NaF PET/CT及冠状动脉造影(CAG)检查,PET/CT显像均在山西医科大学第一医院进行。随访患者治疗后主要心血管不良事件(MACE)。建立ROC曲线,获得SUVmax及冠状动脉主要分支所有病灶处SUVmax累积值(S-SUVmax)预测MACE的最佳阈值,采用Cox比例风险模型和Kaplan-Meier方法(log-rank检验)分析PET参数对MACE的预测价值。组间代谢参数差异行Mann-WhitneyU检验。结果54例患者中位随访时间为6.0(1.8,6.6)年,13例(24.1%)发生MACE,包括7例死亡、5例心肌梗死、1例严重心律失常。MACE患者S-SUVmax明显高于非MACE组[2.64(2.08,4.49)与1.83(0.95,2.90);Z=-2.04,P=0.041];ROC曲线示S-SUVmax预测MACE的最佳阈值为2.05(AUC=0.690);多因素Cox分析示,S-SUVmax是MACE的强力预测因子[风险比(HR)=2.434(95%CI:1.547~3.828),P<0.001]。ROC曲线示SUVmax预测MACE的最佳阈值为0.55(AUC=0.659),单因素Cox分析示SUVmax是预测MACE的因素[HR=10.192(95%CI:2.667~38.953),P=0.001]。在25例不完全血运重建(ICR)患者中,Kaplan-Meier分析示,18F-NaF摄取阳性者[单支中度狭窄(狭窄40%~70%)病变处SUVmax≥0.55]MACE发生率明显高于18F-NaF摄取阴性者(5/14与0/11;χ^(2)=6.07,P=0.014)。结论18F-NaF PET/CT可作为CAD患者MACE的独立预测因子,并可定量评估中度冠状动脉狭窄的远期进展情况;未来其有望成为一种无创指导冠状动脉多支病变再血管化治疗决策的新方式。ObjectiveTo investigate the clinical value of 18F-NaF PET/CT coronary plague imaging in evaluating the long-term prognosis of patients with coronary artery disease(CAD).MethodsA retrospective cohort study was conducted among 54 patients(37 males and 17 females,aged(57.2±9.8)years)diagnosed with CAD from a multicenter study between September 2015 and October 2022.All patients underwent 18F-NaF PET/CT and coronary angiography(CAG)within 1 week,and the PET/CT imaging was performed at the First Hospital of Shanxi Medical University.Major adverse cardiovascular events(MACE)were followed up.ROC curves were established to obtain the optimal thresholds of SUV max and accumulated SUV max of all lesions of main coronary artery branches(S-SUV max)for predicting MACE.Cox proportional risk model and Kaplan-Meier method(log-rank test)were used to analyze the predictive value of PET parameters for MACE.Differences in metabolic parameters between 2 groups were compared by Mann-Whitney U test.ResultsThe median follow-up time of the 54 patients was 6.0(1.8,6.6)years,and 13(24.1%)patients developed MACE,including 7 deaths,5 myocardial infarction and 1 severe arrhythmia.S-SUV max in MACE group was significantly higher than that in the non-MACE group(2.64(2.08,4.49)vs 1.83(0.95,2.90);Z=-2.04,P=0.041).ROC curve showed that the optimal threshold of S-SUV max for MACE prediction was 2.05(AUC=0.690).Multivariate Cox analysis showed that S-SUV max was a strong predictor of MACE(hazard ratio(HR)=2.434(95%CI:1.547-3.828),P<0.001).ROC curve showed that the optimal threshold of SUV max to predict MACE was 0.55(AUC=0.659),and univariate Cox analysis showed that SUV max was a factor to predict MACE(HR=10.192(95%CI:2.667-38.953),P=0.001).In 25 patients with incomplete revascularization(ICR),Kaplan-Meier analysis showed that the incidence of MACE in patients with positive 18F-NaF uptake(single medium stenosis(40%-70%)with SUV max≥0.55)was significantly higher than that in patients with negative 18F-NaF uptake(5/14 vs 0/11;χ^(2)=6.07,P=0.014).

关 键 词：冠状动脉疾病 心肌血管重建术 氟化钠 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R541.4[医药卫生—心血管疾病] R817.4[医药卫生—内科学]