腺苷负荷实验心肌灌注核素显像在冠心病中的临床价值

Diagnostic value of adenosine stress myocardial perfusion tomographic imaging for coronary artery disease

目的评价腺苷负荷试验心肌灌注显像诊断冠心病的敏感性、准确性、特异性。方法对132例临床疑诊冠心病患者,静脉泵入腺苷,剂量为140g/(kg.min),用药时间6min。泵入过程中,行心电监测,观察患者的症状、血压和心率。于泵入腺苷3min末,静脉注射核素显像剂99m锝-甲氧基异丁基异腈核素显像(99mTc-MIBI)925MBq,1.5h后行心肌灌注断层显像,若显像异常,次日行静息心肌显像。所有患者行冠状动脉造影。结果在132例患者中,冠状动脉造影阳性87例,阴性45例,心肌核素显像阳性85例,阴性47例,两种检查结果一致的病例数为108例。心肌核素显像假阳性的病例为11例,假阴性为13例。腺苷负荷试验心肌灌注显像诊断冠心病的敏感性为85.1%(74/87)、特异性为75.6%(34/45)、准确性为81.8%(108/132)。结论腺苷负荷试验心肌核素显像对于冠心病诊断具有重要的临床应用价值。

Objective To evaluate the sensitivity, accuracy and specificity of adenosine stress myocardial perfusion tomographic imaging in the diagnosis of coronary artery disease（CAD）. Methods A total of 132 patients with suspected coronary artery disease were included in the study. Adenosine was infused intravenously at a rate of 140 g/（ kg · min） for 6 min. At the end of 3 min after adenosine infusion ,925 MBq of 99mTc-MIBI was injected intravenously. In this process ,the symptom, blood pressure and heart rate were recorded. SPECT myocardial imaging acquisition was obtained at hour 1.5 after adenosine infusion. If the imaging was abnormal, the resting myocardial perfusion imaging would be obtained at the next day. All patients underwent coronary angiography. Results Of 132 patients, 87 patients showed the positive coronary angiography, and 45 negative ;85 patients showed SPECT myocardial imaging positive, and 47 negative. The unanimous results detected by two methods were found in 108 patients. The false positive results of myocardial scintigraphy were found in 11 patients, and the false-negative in 13. The sensitivity, specificity and accuracy of adenosine myocardial perfusion tomographic imaging for the diagnosis of CAD were 85.1% （74/87） , 75.6% （34/45）and 81.8% （ 108/132 ）. Conclusion Adenosine stress myocardial perfusion tomographic imaging is a useful non-interventional method for detecting coronary artery disease.