铊-201负荷心肌洗脱率评价心肌缺血与冠状动脉血流储备的对比研究  

Assessment of myocardial ischemia by myocardial Thallium-201 washout rate after dipyridamole infusion and comparison study with coronary flow reserve

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

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

出　　处：《中国介入心脏病学杂志》2004年第2期77-79,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　评价铊 2 0 1( 2 0 1 Tl)负荷心肌洗脱率在心肌缺血方面的应用价值 ,观察2 0 1 Tl负荷洗脱率与冠状动脉 (冠脉 )血流储备的相关性。方法　选择经冠脉造影证实的冠心病 (冠脉狭窄≥ 5 0 % )住院患者 2 5例 ,另外 2 3例经冠脉造影检查显示冠脉正常或狭窄 <5 0 %者作为对照组。行2 0 1 Tl双嘧达莫 (潘生丁 )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 %。在核素检查前后两周内行冠脉造影及冠脉内多普勒血流测定。结果　冠脉狭窄组室壁洗脱率显著低于对照组 [前壁 ( 2 6 89± 4 39) %vs ( 4 3 5 4± 9 0 8) % ;下壁 ( 16 81± 6 13) %vs ( 4 5 0 4± 9 6 6 ) % ;侧壁 ( 2 7 76± 9 0 1) %vs ( 4 3 87± 9 17) % ,P <0 0 0 1];冠脉狭窄组所测冠脉血流储备 (CFR =充血相平均峰值流速 静息相平均峰值流速 )值显著低于对照组CFR( 1 6 7± 0 6 3vs 2 85± 0 6 4 ,P <0 0 0 1) ;前壁洗脱率与前降支狭窄程度的相关性、侧壁洗脱率与回旋支狭窄程度的相关性差 (r =- 0 4 6 9,P =0 0 5 ;r =- 0 394 ,P =0 16 4 ) ;但下壁洗脱率与右冠脉狭窄程度之间的相关性较好 (r=- 0 6 6 1,P =0 0 0 5 ) ;Objective To assess the applicable value of myocardial thallium 201 ( 201 Tl) washout rate (WR) after dipyradamole infusion in detection of myocardial ischemia, and to evaluate the correlation between myocardial 201 Tl WR obtained by myocardial scintigraphy single photon emission computed tomography (SPECT) and coronary flow reserve (CFR) measured by intracoronary Doppler guide wire Methods Twenty five patients with coronary artery disease (CAD) demonstrated by angiogram were enrolled Twenty three patients with no detectable heart disease were studied in the control group Regional myocardial WR of 201 Tl was measured from early and delayed bull's eye images of dipyridamole 201 Tl SPECT Around 2 weeks after or before 201 Tl myocardial scintigraphy, angiogram and intracoronary Doppler velocity measurement were performed Results The myocardial 201 Tl 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) The CFR in CAD patients was also lower than that in the controls (1 67±0 63 vs 2 85±0 64, P <0 001) There was a poor correlation between the WR of 201 Tl in anterior wall and the stenosis degree of LAD, as well as between lateral wall and LCx( r =-0 469～-0 394, P =0 05～0 164) But the correlation between the WR in inferior wall and the stenosis degree of RCA was better ( r =-0 661, P =0 005) The myocardial WR of 201 Tl was significantly correlated with CFR ( r =0 753～0 858, P <0 001) Conclusion In CAD patients, the regional WR of 201 Tl in ischemic area was lower than that in the controls The CFR in patients with CAD was much lower than that in the controls And there was a significant correlation between myocardial WR of 201 Tl and CFR But a further study i

关 键 词：铊-201 心肌洗脱率 心肌缺血 冠状动脉 血流储备 心肌梗死 

分 类 号：R542.2[医药卫生—心血管疾病]