核素心肌灌注显像诊断代谢综合征心肌缺血的研究

Features of myocardial ischemia in metabolic syndrome patients as diagnosed by myocardial nuclein perfusion imaging

目的评估代谢综合征(MS)患者心肌缺血及相关危险因素,探讨核素心肌灌注显像诊断冠心病的价值.方法 140例住院患者分为3组:MS组(82例),高血压病组(EH组,38例),2型糖尿病组(T2DM组,20例).3组均又分为运动负荷组和静息组,采用单光子发射计算机断层核素心肌灌注显像(SPECT MPI)的方法检测各组心肌缺血情况.结果 MS组心肌缺血率为81.7%,重度缺血率为56.8%,均高于其他两组(P＜0.05).核素检查运动负荷组缺血率为81.7%,明显高于静息组(P＜0.01).BMI、腹围、血TG、血HDL-C与缺血有相关性.结论与EH组和T2DM组患者相比,MS组患者心肌缺血率和严重程度最高;其中MS某些组分与心肌缺血密切相关;心肌核素检查用于诊断早中期心肌缺血、判断中度危险的冠心病有临床价值.

Objective To assess myocardial ischemia in metabolic syndrome （MS）, and risk factors of coronary heart disease （CHD） in MS, and to evaluate myocardial nuclein perfusion imaging （MPI）. Methods 140 in-patients were divided into three groups according to the diseases they suffered from： metabolic syndrome （MS）： 82 cases （m/f= 54/28）, essential hypertension （EH）： 38 cases （m/f=15/ 23）, and diabetes mellitus （DM） ： 20 cases （m/f=10/10）. The degree of myocardial ischemia was detected by myocardial perfusion singlephoton emission computed tomography （SPECT MPI）. Results （1） The percentage of myocardial ischemia in MS group was 81.7%, and 56.8% of the patients in this group suffered from severe ischemia. Both percentages were higher than that in the other two groups （P〈 0. 05）. （2） The percentage of myocardial ischemia in exercise stress MPI was 81.7%, which was higher than that of resting MPI （P〈 0. 01）. （3） The total percentage of myocardial ischemia in the 140 in-patients was 87. 1%. Among them dynamic electrocardiogram exami- nation was performed in 106 patients, and the sensitivity of this technique was 37. 6%, and its specificity was 84. 6%; the total coincident rate with MPI was 43. 4%. （4） BMI, abdominal perimeter, triglyceride, high density lipoprotein-cholesterol were correlated with myocardial ischemia. Conclusions The percentage of myocardial ischemia and that of severe ischemia were highest in MS compared with EH and DM groups;some of the components in MS were highly correlated with myocardial ischemia. MPI was of clinical value in the diagnosis of early and moderate myocardial ischemia.