^(99m)Tc-MIBI/^(18)F-FDG双核素显像对冠心病患者存活心肌的评价

Evaluation of myocardial viability in patients with coronary heart disease using ^(99m)Tc-MIBI/^(18)F-FDG myocardial tomography with dual isotope simultaneous acquisition

目的应用99mTc-甲氧基异丁基异腈(MIBI)和18F-脱氧葡萄糖(FDG)双核素显像(DISA)比较直接经皮冠状动脉(简称冠脉)介入治疗(PCI)与择期PCI对急性心肌梗死(AMI)患者心肌存活性的影响以及不稳定性心绞痛(UA)患者心肌存活性。方法将63例冠心病患者分为3组:心肌梗死(MI)1组:行直接PCI的AMI患者21例;MI2组:行择期PCI的AMI患者20例;UA组:行PCI的UA患者22例;上述三组于PCI后1周内行DISA检查。对照组(C组):冠状动脉造影术(CAG)示冠脉正常者17例,于CAG后1周内行DISA检查。分别比较MI1组、MI2组、UA组和C组间左室心肌灌注减低节段数占总节段数百分比和灌注减低节段中18F-FDG显像有明显改善节段百分比。四组间两两样本均数间比较用t检验,两组间百分率的比较用χ2检验。结果MI1组与MI2组比较:心肌灌注减低节段分别为21.7%(41/189个)和34.3%(62/180个),两组比较差异有统计学意义(χ2=7.5,P<0.05);存活节段分别为70.7%(29/41个)和43.5%(27/62个),两组间比较差异有统计学意义(χ2=7.33,P<0.05);UA组的心肌灌注减低节段为21.2%(42/198个),与MI1组比较差异无统计学意义(χ2=0.01,P>0.05),与MI2组比较差异有统计学意义(χ2=8.27,P<0.05);存活节段为83%(35/42个),与MI1组比较差异无统计学意义(χ2=1.87,P>0.05),与MI2组比较差异有统计学意义(χ2=16.5,P<0.05)。结论直接PCI能更大程度地挽救AMI患者的存活心肌,更有效地保护心脏功能和改善预后;在UA患者缺血心肌中存在局灶性坏死。

Objective To evaluate the myocardial viability and cardiac function in patients with coronary heart disease after percutaneous coronary intervention(PCI)therapy using 99mTc-MIBI/18F-FDG myocardial tomography with dual isotope simultaneous acquisition(DISA).Methods A total of 63 patients with coronary heart disease underwent PCI therapy,including MI1 group(21 acute myocardial infarction patients who get primary PCI),MI2 group(20 acute myocardial infarction patients who get selective PCI)and UA group(22 unsta...