腺苷与运动负荷心肌灌注显像诊断不典型胸痛心肌缺血的临床价值

Clinical evaluation of adenosine and exercise stress ^(99)Tc^m-MIBI myocardial imaging in detection of myocardial ischemia in patients with untypical chest pain

目的评价腺苷和运动负荷心肌灌注显像诊断不典型胸痛患者心肌缺血的价值。方法不典型胸痛患者67例行腺苷负荷心肌灌注显像,81例行运动负荷心肌灌注显像,结果分别与冠状动脉(简称冠脉)造影比较,得到显像诊断冠心病心肌缺血的灵敏度、特异性和准确性。结果腺苷负荷心肌灌注显像组67例中,23例冠脉造影有狭窄病变,腺苷负荷心肌灌注显像检出可逆性灌注异常即诊断心肌缺血16例,44例冠脉造影阴性者中,腺苷心肌灌注显像正常41例。腺苷负荷心肌灌注显像诊断冠心病心肌缺血的灵敏度为70%,特异性93%,准确性85%。运动负荷心肌灌注显像组81例中,31例冠脉造影阳性,运动负荷心肌灌注显像检出心肌缺血22例,50例冠脉造影阴性者中,运动负荷心肌灌注显像正常48例。运动负荷心肌灌注显像诊断冠心病心肌缺血的灵敏度为71%,特异性96%,准确性86%。结论腺苷或运动负荷心肌灌注显像出现可逆性灌注异常对诊断不典型胸痛患者冠心病心肌缺血有重要意义。

Objective To evaluate the value of adenosine and exercise stress ^99Tc^m-methoxyisobutylisonitrile （MIBI） myocardial imaging for the diagnosis of myocardial ischemia in patients with untypical chest pain. Methods Two groups included. Group 1 ： 67 cases of adenosine ^99Tc^m-MIBI myocardial imaging. Group 2：81 cases of exercise stress ^99Tc^m-MIBI myocardial imaging. All of the patients had coronary angiography（CAG）. The results of them were compared. Results 23 out of 67 patients in group 1 had significant coronary stenosis after CAG, 16 showed reversible perfusion abnormalities in adenosine imaging. 41 of 44 patients with normal CAG showed normal adenosine imaging. The sensitivity, specificity and accuracy of adenosine imaging for coronary artery disease detection were 70% , 93% and 85% , respectively. Group 2：22 out of 31 patients with significant coronary stenosis after CAG showed reversible perfusion abnormalities, 48 of 50 patients with normal CAG showed normal exercise imaging. The sensitivity, specificity and accuracy of exercise imaging for coronary artery disease detection were 71% , 96% and 86% , respectively. Conclusion Reversible perfusion abnormalities found both in adenosine and exercise stress ^99Tc^m-MIBI myocardial imaging were the key point for diagnosis of myocardial ischemia in patients with untypical chest pain.