重组组织型纤溶酶原激活剂静脉溶栓及延迟支架置入治疗急性心肌梗死的心肌灌注断层显像对比研究

A comparative study of intravenous rt-PA thrombolysis and late intracoronary stenting in the treatment of acute myocardial infarction using ^(99)Tc^m-MIBI SPECT imaging

目的比较静脉溶栓,静脉溶栓+延迟冠状动脉内支架置入术(溶栓+延迟支架)和延迟冠状动脉内支架置入术(延迟支架术)在急性心肌梗死治疗中的效果。方法95例急性心肌梗死(AMI)患者分为3组,溶栓组31例,溶栓+延迟支架组30例,延迟支架组34例,溶栓组于溶栓后3周,后二组于支架术后1周(全部病例均于入院后3周)行99Tcm-甲氧基异丁基异腈(MIBI)心肌断层显像(SPECT)。将左心室心肌分为16个节段,用半定量法对其心肌摄取99Tcm-MIBI的程度进行打分,并计算每个患者心肌显像的总积分。结果溶栓组、溶栓+延迟支架组、延迟支架组三者心肌显像的总积分分别为28.4±7.5,19.4±6.2,27.3±7.2,溶栓+延迟支架组分别与溶栓组和延迟支架组比较,差异均有统计学意义(t=7.2,t=6.9,P<0.01),溶栓组与延迟支架组比较差异无统计学意义(t=1.3,P>0.05)。结论在AMI的治疗中,溶栓+延迟支架疗效明显优于单纯溶栓和单纯延迟支架方法,而溶栓法和延迟支架法可能基本相同;99Tcm-MIBI心肌SPECT显像可作为判断溶栓、溶栓+延迟支架和延迟支架治疗AMI疗效的比较客观的指标。

Objective To evaluate and compare the therapetic effectiveness among intravenous rt-PA thrombolysis, thrombolysis plus delayed intracoronary stenting and delayed intracoronary stenting for acute myocardial infarction （AMI） using ^99T^cm-MIBI myocardial SPECT imaging. Methods Ninty-five cases of AMI were divided into three groups which were the thrombolysis group （ n = 31）, thrombolysis plus delayed stenting group （ n = 30） and the delayed stenting group （ n = 34）. ^99T^cm-MIBI myocardial SPECT imaging was performed 3 weeks after thrombolysis therapy or 1 week after intracoronary stenting. The left ventricular myocardium was divided into 16 segments for evaluation. The score of myocardial ^99T^cm-MIBI uptake were analyzed semiquantitatively and the total, score of myocardial ^99T^cm-MIBI uptake was calculated. Results The scores of the 3 groups were 28.4 ± 7.5, 19.4 ± 6.2 and 27.3 ± 7.2 respectively. Significant difference was shown in the thrombolysis plus delayed stenting group compared with the thrombolysis and the delayed stenting group （ t = 7.2, t = 6.9, P 〈 0.01 ）. There was no difference in the uptake of ^99T^cm-MIBI between the 2 groups of thrombolysis and delayed stenting （t = 1.3, P 〉 0.05）. Conclusion ^99 T^cm-MIBI myocardial SPECT imaging has been proved to he an objective parameter for evaluating the therapeutic effectiveness of the various treatments of AMI. Thrombolysis plus delayed stenting seems to be more effective than thrombolysis and delayed stenting. On the other hand, thrombolysis and delayed stenting show similar effect in the treatment of AMI in the study.