核素心肌灌注显像在冠心病危险度分层中的临床意义

Clinical significance of risk stratification of patients with coronary artery disease using nuclear myocardial perfusion imaging

目的评价核素心肌灌注显像在冠心病危险度分层中的临床价值及意义。方法对均进行了核素心肌灌注显像[核素选用^99mTc-甲氧基异腈（MIBI），心肌灌注显像采用静息-腺苷药物负荷试验]及冠状动脉（简称冠脉）造影的13例患者进行观察和对比，对核素心肌灌注显像阳性者10例、核素心肌灌注显像阴性者3例与各自的冠脉造影对比，评判核素心肌灌注显像对胸闷、胸痛等不同症状患者心肌缺血程度初步估测，并进行危险评估。结果核素心肌灌注显像提示严重心肌缺血6例，在相应冠脉造影中均发现冠脉病变多为2支以上，且狭窄程度多在70％以上，均进一步行球囊扩张和（或）支架置入术；提示轻度心肌缺血4例，随后冠脉造影发现多为1支病变，狭窄程度多为50％～70％，均进行药物治疗；另3例核素心肌灌注显像阴性者冠脉造影无明显异常发现。结论核素心肌灌注显像对冠心病进行危险度分层及选择治疗、评估预后有重要意义。

Objective To evaluate the clinical significance of risk stratification of patients with coronary artery disease using nuclear myocardial Perfusion imaging. Methods Resting and stress （adenosine infusion） myocardial perfusion studies （^99mTc- MIBI） were performed in 13 patients with chest pain and discomfort for risk stratification. All patients underwent coronary angiography. Results Six patients had severe myocardial ischemia demonstrated by myocardial perfusion study. All six patients had multi-vessel coronary artery disease involving 2 or more coronary arteries with stenosis of more than 70%. The patients underwent coronary angioplasty with coronary artery stents. Four patients had mild ischemia and coronary angiography showed 50%-70% stenosis in one coronary artery. Three patients had no ischemia by myocardial perfusion study and coronary artery angiography showed no significant coronary artery disease. Three-month to one-year follow-up showed satisfactory results. Conclusion Nuclear myocardial perfusion imaging plays an important role in the selection of treatment and prediction of prognosis in coronary artery disease.