冠状动脉微血管病变铊-201负荷心肌洗脱率的变化  

Myocardial thallium-201 washout rate in patients with coronary microvascular disease

作　　者：马士新[1] 魏盟[1] 张海宁 王齐冰[3] 石洪成[3] 姚之丰[3] 陈绍亮[3] 

机构地区：[1]上海市第六人民医院心内科,上海200233 [2]山东省无棣县人民医院放射科 [3]复旦大学附属中山医院

出　　处：《临床心血管病杂志》2003年第7期426-428,共3页Journal of Clinical Cardiology

摘　　要：目的 :观察冠状动脉 (冠脉 )无明显狭窄 (<5 0 % )而冠脉血流储备异常患者的铊 2 0 1(2 0 1T1)负荷心肌洗脱率。方法 :随机测定 2 3例冠脉造影示冠脉正常或狭窄 <5 0 %患者不同冠脉的血流储备值 ,并根据冠脉血流储备 (CFR)分为 2组 :A组为CFR≥ 2 .5 (正常对照组 ) ,包括 34支冠脉 ;B组为CFR <2 .5 (冠脉微循环异常组 ) ,包括 16支冠脉。 2 3例受试者分别行2 0 1Tl潘生丁负荷心肌显像检查 ,处理出靶心图后 ,计算两组局部室壁洗脱率。洗脱率 =(负荷态放射性计数 -延迟态放射性计数 ) /负荷态放射性计数× 10 0 %。另根据心电图正常与否将上述患者分为两组 :组Ⅰ 12例 ,心电图完全正常 ;组Ⅱ 11例 ,平时心电图存在非特异性ST T改变 [成组导联的T低平或倒置和 (或 )ST压低≥ 0 .5mV]。比较两组的室壁洗脱率。结果 :A组的室壁洗脱率高于B组[(4 8.91± 7.75 ) %∶(36 .11± 6 .80 ) % ,P <0 .0 1];心电图有ST T改变的 11例受试者的相应 13段室壁洗脱率下降 ,为 (39.2 5± 7.86 ) % ,低于心电图完全正常的 12例受试者的 36段室壁洗脱率 [(4 9.5 6± 7.31) % ,P <0 .0 1]。结论Objective:To observe the myocardial 201 Tl washout rate (WR) in patients with decreased coronary flow reserve (CFR) but no visually obstructive coronary lesions.Methods:Twenty three patients (male 13,female 10,aged 57.09 ± 11.83 ) who had atypical chest pain but no detectable heart disease was selected. CFR of coronary arteries were measured, and the coronary arteries were divided into Group A (34 arteries) with CFR≥ 2.5 and Group B (16 arteries) with CFR< 2.5 . In addition, according to the manifestation of the electrocardiogram, the 23 patients were divided into Group I (12) with normal electrocardiogram (ECG) and Group II (11) with abnormal manifestation of ST T. Regional myocardial WR of 201 Tl was measured from early and delayed bull's eye images of dipyridamole 201 Tl SPECT.Results:In the 23 subjects with no obviously stenosed coronary arteries, the WR of 201Tl in areas which were affected by these coronary arteries with CFR< 2.5 was much lower than that in areas which were supported by those coronary arteries with CFR≥ 2.5 ( 36.11 ± 6.80 )% vs (48.91± 7.75 )%, P< 0.01 ). And the myocardial WR of 201 Tl in patients with abnormal manifestation of ST T was also lower than that in subjects with normal ECG. ( 39.25 ± 7.86 )% vs ( 49.56 ± 7.31 )% P< 0.01 ).Conclusion:The myocardial WR of 201 Tl is decreased in patients with abnormal CFR (CFR< 2.5 ) or ECG but no significant coronary stenosis.

关 键 词：冠状动脉疾病 微血管病 铊-201 放射性核素心室显像术 

分 类 号：R541.1[医药卫生—心血管疾病]