铊-201负荷心肌洗脱率在冠心病筛选中的应用价值  

Value of Thallium-201 myocardial washout rate after dipyridamole infusion in screening coronary artery disease

作　　者：马士新[1] 魏盟[1] 石洪成[2] 姚之丰[2] 王齐冰[2] 钱菊英[2] 李文罡[2] 陈绍亮[2] 

机构地区：[1]上海市第六人民医院,上海交通大学附属第六人民医院心内科,200233 [2]复旦大学附属中山医院

出　　处：《上海医学》2003年第9期657-659,共3页Shanghai Medical Journal

摘　　要：目的　评价铊 2 0 1(2 0 1Tl)负荷心肌洗脱率在冠心病筛选方面的应用价值。方法　选择经冠状动脉造影证实的冠心病 (冠状动脉狭窄≥ 5 0 %)住院患者 34例 ,以 2 3例经冠状动脉造影检查显示冠状动脉正常或狭窄 <5 0 %者作为对照组。行2 0 1Tl双嘧达莫负荷心肌显像检查 ,处理出靶心图后 ,计算局部室壁洗脱率。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 %。在核素检查前、后 2周内行冠状动脉造影检查。结果　冠状动脉狭窄组室壁洗脱率显著低于对照组 (P <0 .0 0 1) ,前者前壁为 (2 6 .89± 4.39) %、下壁为 (16 .81± 6 .13) %、侧壁为 (2 7.76± 9.0 1) %,后者分别为 (43.5 4± 9.0 8) %、(45 .0 4± 9.6 6 ) %和 (43.87± 9.17) %。前壁洗脱率与前降支狭窄程度及侧壁洗脱率与回旋支狭窄程度不相关 (r =- 0 .46 9,P =0 .0 5 ;r =- 0 .394,P =0 .16 4) ;下壁洗脱率与右冠状动脉狭窄程度呈负相关 (r =- 0 .6 6 1,P =0 .0 0 5 )。结论　冠状动脉明显狭窄患者的2 0 1Tl洗脱率显著下降 ,洗脱率可作为冠心病筛选的一种无创方法。对于冠状动脉狭窄程度与室壁洗脱率之间的相关性需要大样本进一步研究。Objective To assess the value of myocardial thallium-201( 201Tl)washout rate (WR) after dipyradamole infusion in screening coronary artery disease.Methods 34 patients with coronary artery disease (CAD) demonstrated by angiogram were enrolled. 23 patients who had atypical chest pain with mild coronary artery stenosis(<50%) were taken as the control group. Regional myocardial WR of 201Tl was measured from early and delayed bull's eye images of dipyridamole 201Tl SPECT. Around 2 weeks before or after 201Tl myocardial scintigraphy, angiograms were performed.Results The myocardial 201Tl WR after dipyridamole infusion in patients with CAD was significantly less than that in the controls [anterior wall (26.89±4.39)% vs (43.54±9.08)%; inferior wall (16.81±6.13)% vs (45.04±9.66)%; lateral wall (27.76±9.01)% vs (43.87±9.17)%, P< 0.001]. There was a poor correlation between the WR of 201Tl in anterior wall and the stenotic degree of LAD, as well as between lateral wall and LCx (r=-0.469, P=0.05; r=-0.394, P=0.164). But the correlation between the WR in inferior wall and the stenotic degree of RCA was better shown (r=-0.661, P=0.005).Conclusion In CAD patients, the regional WR of 201Tl in ischemic area was less than that in the controls. But the correlation between the WR and the degree of coronary stenosis needs further study.

关 键 词：冠心病 铊-201 负荷心肌洗脱率 临床应用 诊断 

分 类 号：R541.4[医药卫生—心血管疾病]