^(99m)Tc-MIBI心肌断层显像对急性心肌梗塞病人溶栓后存活心肌判断的研究

Assessment of myocardial viability of patients with acute myocardial infarction after thrombolytic treatment with of^(99m)Tc-MIBI SPECT

探索一种更为简便实用的方法,以观察溶栓对急性心肌梗塞(AMI)病人溶栓2周后的冬眠心肌有无影响。将64例 AMI 病人分为溶栓组、非溶栓组、溶栓成功组和溶栓未成功组。舌下含硝酸甘油(NTG)与静态(99m)~Tc-甲氧基异丁基异腈(MIBI)心肌 SPECT 显像相结合,测各组病人的存活心肌。用圆周剖面法进行定量分析,以存活分数为判断指标。4组病人的心肌存活率和存活分数分别为63%、42%、79%、43%和0.36±0.24、0.18±0.16、0.39±0.14、0.15±0.13,溶栓组和溶栓成功组的心肌存活率及存活分数明显高于其它两组(P<0.05)。64例 AMI 患者中有36例做了冠状动脉造影,其结果与核素心肌显像有良好的相关性(r=0.93,P<0.01)。以14例病人经皮腔内冠状动脉成形术后的(99m)Tc-MIBI 心肌 SPECT 显像结果作为判断存活心肌的金标准,口含 NTC 与静态(99m)~Tc-MIBI 心肌 SPECT 显像相结合的定量方法检出存活心肌的准确率为88.9%。故口含 NTC 与静态(99m)~Tc-MIBI 心肌灌注断层显像相结合的定量方法可用于测定 AMI 病人的存活心肌,且实用简便。溶栓疗法可为 AMI 病人争取到更多的存活心肌和进一步治疗的时机。

PURPOSE The purpose of this study is to look for a simple and useful approach for detecting viable myocardium of the pa- tients with acute myocardial infarction (AMI) after thrombolytic treatment.METHODS 64 patients with AMI after thrombolytic treat- ment were subdivided into four groups:groupⅠ with thrombolytic treatment,groupⅡ without thrombolytic treatment,groupⅢ with suc- cessful thrombolytic treatment,groupⅣ without sueessful thrombolytic treatment.All patients were studied using nitroglcerine (NTG) in- terventional ^(99m)Tc-MIBI myocardial tomography.The viability fraction (VF) was used as an index of viable myocardium.RESULTS VF of groupⅠ、groupⅡ、groupⅢ and groupⅣ was 0.36±0.24、0.18±0.16、0.39±0.14 and 0.15±0.13 respectively.There was significant difference between groupⅠ and groupⅢ vs groupⅡ and groupⅣ(P<0.05).In 14 patients who had PTCA,out of 14 segments with im- proved perfusion during NTG imaging,13 segments showed an improvement after PTCA with an accuracy of 88.9%.CONCLUSIONS ^(99m)Tc-MIBI SPECT combined with oral NTG imaging was a useful approach for detecting viable myocardium of the patients with AMI with thrombolytic treatment.The results indicated that the VF of reversible segments with thrombolytic treatment was significantly higher than these without thrombolytie treatment.