硝酸甘油介入核素心肌灌注显像评价2型糖尿病患者心肌微血管损伤的研究

Evaluation of myocardial microvascular damage in patients with type 2 diabetes by^(99m)Tc- methoxyisobutylisonitrile myocardial perfusion imaging

目的描述2型糖尿病(T2DM)患者心肌微血管损伤在心肌灌注显像(MPI)中的影像学特征,探讨影像学特征与糖尿病微血管损伤程度的关系。方法将103例T2DM患者分为2组:冠状动脉造影(CAG)正常组(狭窄<50%)35例和CAG异常组(狭窄≥50%)68例。对2组病例分别进行99mTc-甲氧基异丁基乙腈(MIBI)静息MPI(R-MPI)和硝酸甘油介入MPI(NTG-MPI),并应用ECToolbox软件对显像结果进行定性与半定量分析。结果103例患者中,R-MPI共检出灌注稀疏256个节段,其中CAG正常组75个节段,CAG异常组181个节段(χ2=8.90,P<0.01)。NTG-MPI共检出灌注稀疏426个节段,其中CAG正常组137个节段,CAG异常组289个节段(χ2=1.09,P>0.05)。CAG正常组反向再充填62个节段,占30.7%(62/202);CAG异常组反向再充填145个节段,占32.7%(145/443);两组相比,χ2=0.26,P>0.05。CAG正常组患者R-MPI总评分(SRS)、N-MPI总评分(SSS)、SRS与SSS差异值(SDS)与CAG异常组相比,t值分别为7.57、7.74、7.46,P值均<0.01。103例T2DM患者中,SDS<0者57例,占55.3%;SDS>0者39例,占37.9%;两者相比,χ2=6.32,P<0.05。无论是SDS>0还是SDS<0,CAG正常组与异常组之间都有显著性差异(t=5.46、7.92;P值均<0.01)。结论 NTG-MPI中心肌缺血节段的数量和严重程度在一定程度上能反映T2DM患者冠状循环微血管损伤程度。

Objective To characterize the myocardial microvascular damage in patients with type 2 diabetes using radionuclide myocardial perfusion imaging(MPI), and to evaluate the correlations between image characteristics and the severity of diabetic microvascular damage. Methods One hundred and three patients with type 2 diabetes were divided into normal coronary angiography(CAG) group(35 cases, with stenosis<50%) and abnormal CAG group(68 cases, with stenosis ≥50%). The resting and nitroglycerin(NTG)-augmented99mTc-methoxyisobutylisonitrile(MIBI) MPI(R-MPI and NTG-MPI) were performed in all cases. Qualitative and semi-quantitative analyses were performed with ECToolbox software. Statistic analysis was performed with SPSS 13.0 software. Results In all of the 103 cases, 256 perfusion-defect segments were detected by R-MPI(75were in normal CAG group and 181 in abnormal CAG, χ2=8.90,P<0.01), and 426 perfusion-defect segments were detected by NTG-MPI(137 in normal CAG group and 289 in abnormal CAG abnormal, χ2=1.09, P>0.05). Reverse redistribution were identified in 62(30.7%, 62/202) segments in normal CAG group and 145(32.7%, 145/443) segments in abnormal CAG group(χ2=0.26,P>0.05). The summed rest score(SRS), summed stress score(SSS) and summed difference score(SDS) between the two groups were significantly different(t=7.57, P<0.01; t=7.74, P<0.01; t=7.46, P<0.01). Of all the cases, 57(55.3%, 57/103)had SDS<0 and 39(37.9%, 39/103) SDS>0(χ2=6.32, P<0.05). There were significant differences between the two groups when SDS<0 or ≥0(t=5.46, P<0.01; t=7.92, P<0.01). Conclusion The quantity and severity of ischemic myocardial segments detected by N-MPI may reflect the extent of coronary microvascular damage in patients with type 2 diabetes.