高血压患者^(99m)Tc-MIBI心肌灌注及硝酸甘油介入显像的初步探讨

Myocardial Perfusion Imaging and Nitroglycerin Intervention Imaging in Patients with Hypertension

目的对高血压病人的９９ｍＴｃ－ＭＩＢＩ心肌灌注断层显像的临床意义进行探讨。方法１０５例高血压患者进行９９ｍＴｃ－ＭＩＢＩ负荷（运动或ＡＴＰ介入）和／或静息心肌灌注断层显像，其中５２例与１０例心肌灌注显像出现放射性异常减低的病人于２４～４８ｈ后分别进行硝酸甘油介入心肌显像与卡托普利介入心肌显像。结果高血压患者心肌灌注显像异常发生率８０．０％。２２例冠脉造影有１０例（５５．６％）证实为高血压合并冠脉狭窄≥５０％。硝酸甘油介入心肌显像使放射性减低节段填充或部分填充（血流灌注改善）６４．４％，无填充３１．１％，与冠心病心肌缺血组比较，差异有非常显著意义（Ｐ＜０．０１）；卡托普利介入心肌显像能使减低节段填充或部分填充占５３．８％。结论高血压患者心肌灌注显像所表现的放射性异常减低，其原因可有合并冠心病。心内局部合成肾素－血管紧张素参与，而高血压性心肌病变也是重要的原因。硝酸甘油介入与卡托普利介入心肌显像是鉴别上述病因的有效方法。

Aim\ To detect the characteristics of myocardial perfusion imaging in patients with hypertension.\ Methods\ Rest/stress 99m Tc MIBI were performed in 105 patients with hypertension.\ 52 patients with abnormal findings underwent nitroglycerin intervention and 10 captopril intervention 24￣48 hrs later.\ Results\ The overall sensitivity for myocardial SPECT of hypertension was 80%.\ 22 of these cases were examined by coronary angiography,and only 10 cases were verified had coronary artery stensis ≥50%.\ 64 4% of myocardial perfusion detects showed complete or partial filling after the administration of nitroglycerin.\ 31 1% showed no refilling on contrary,which was significantly different compared with that in patient with coronary heart disease(CAD)(P<0 01).\ 53 8% of myocardial perfusion defects showed complete or partial refilling after captopril intervention.\ Conclusion\ Nitroglycerine and captopril intervention in myocardial SPECT is able to discriminate hypertensive myocardial changes and those complicated by CAD.