^(99m)Tc-MIBI运动后早期门控心肌显像诊断冠心病的价值

Diagnostic value of ECG-gated early post-exercise ^(99m)Tc-MIBI myocardial perfusion imaging in coronary artery disease

目的:比较99mTc-MIBI门控心肌显像(G-MPI)与传统的非门控心肌显像(NG-MPI)对冠心病(CHD)的诊断价值。方法:215例同期1个月内做负荷(运动后15~20min)/静息2日法99mTc-MIBIG-MPI和冠状动脉造影的CHD患者,以冠状动脉直径狭窄≥50%为诊断标准,比较NG-MPI和G-MPI的诊断价值。结果:心电图运动试验(ETT)、NG-MPI和G-MPI诊断CHD的敏感性分别为:58.0%,88.3%,90.7%;特异性分别为:67.9%,79.2%,88.7%。NG-MPI和G-MPI的敏感性与ETT相比均差异有统计学意义(P<0·01)。G-MPI的诊断敏感性比NG-MPI有增高趋势,但两者比较差异无统计学意义(P>0·05)。在诊断特异性方面,G-MPI与ETT相比差异有统计学意义(P<0·01);对男、女2个性别的特异性分析发现,G-MPI对女性诊断特异性的增加尤其显著。对于严重CHD(狭窄≥70%),G-MPI对严重3支病变的诊断敏感性显著高于NG-MPI(100%∶92·2%,P<0·05)。结论:G-MPI对诊断CHD的价值显著优越于ETT,也优于NG-MPI。

Objective：To study and compare the diagnostic value of ECG-gated and non ECG-gated early postexercise stress ^99mTc-MIBI myocardial perfusion imaging （MPI） in coronary heart disease （CHD）. Method： Two hundred and fifteen known or suspected CHD patients who had undergone coronary angiography and ECG-gated MPI within one month in our hospital were enrolled and values of diagnostic sensitivity, specificity were gained and compared among ETT, non ECG-gated MPI and ECG-gated MPI. Result： When angiographic diameter stenosis ≥50% is the diagnostic standard of CHD, the sensitivity of ETT, non ECG-gated MPI and G-MPI are 58.0% （94/162） ,88.3%（143/162）,90.7%（147/162） ,respectively;the specificity are 67.9%（36/53）,79.2%（42/53）, 88. 7% （47/53） , respectively. ETT, non ECG-gated MPI and ECG-gated MPI have incremental diagnostic value in order with the latter two significantly better than ETT （both P 〈0. 01）. The specificity of non ECG-gated MPI was better than that of ETT （ P 〉0. 05）, and less than ECG-gated MPI （ P 〉0. 05）, while the specificity of ECG-gated MPI is superior to ETT significantly （ P 〈0. 01）. Conclusion： In CHD diagnoses, ECG-gated MPI is significantly better than ETT,and possibly better than non ECG-gated MPI.