多巴酚丁胺负荷ECT心肌显像对冠心病的诊断价值

The Diagnostic Value of Dobutamine loaded Single photon Emission Computed Tomography on Coronary Heart Disease

目的比较多巴酚丁胺负荷ＥＣＴ心肌显像、静息ＥＣＴ、运动ＥＣＴ心肌显像对冠心病的诊断率。方法采用９９ｍＴｃＭＩＢＩＳＰＥＣＴ心肌断层显像及计算机图像分析处理，观察正常人及冠心病病人ＳＰＥＣＴ心肌断层显像阳性出现的敏感性与特异性。结果１３例正常人多巴酚丁胺负荷前后假阳性率分别为１５．４％和２３％（Ｐ＞０．０５），３４例冠心病病人阳性ＳＰＥＣＴ心肌断层显像敏感性由负荷前的４６．３％提高到负荷后的６１．７％（Ｐ＜０．０５），特异性由负荷前６１％提高到负荷后的７６．６％（Ｐ＞０．０５），运动负荷前后ＳＰＥＣＴ对心肌灌注不良检测的敏感性由４６．３％提高至７２％（Ｐ＜０．０５），特异性由６１％提高至７２％（Ｐ＞０．０５）。与多巴酚丁胺试验相比较，两者对检测心肌灌注不良的敏感性及特异性无明显差别。结论多巴酚丁胺负荷ＥＣＴ心肌显像与运动负荷ＥＣＴ心肌显像一样可提高冠心病病人的检出率，不增加假阳性率。对不适于做运动负荷的患者，药物负荷是一种可供选择的方法。

Objection\ To compare the the diagnostic value of dobutamine(DB) loaded single photon emission computed tomography(SPECT),exercise(EX) loaded and rest SPECT on coronary heart disease(CHD) \ Methods\ To test the sensitivity and specificity of myocardial scintigraphy with Technetium 99m hexa kis 2 methoxy isobutyl isonitrile( 99m Tc MIBI) on the CHD and normal controls \ Results\ The false positive rate of 13 cases of the normal controls before and after DB loaded SPECT was 15 4% and 23%(P>0 05) respectively,which revealed that DB loaded SPECT didn′t increase the false positive rate \ The sensitivity and specificity of myocardial scintigraphy with SPECT on 34 cases of CHD was increased from 46 3% to 61 7%(P>0 05) and 61% to 76 6%(P>0 05) after DB load,which showed that DB loaded SPECT test increased the sensitivity of hypoperfution,but didn′t change the specificity \ The sensitivity and specificity of myocardial scintigraphy was increased from 46 3% to 72%(P>0 05) and 61% to 72%(P>0 05) after EX load \ There was no difference of the sensitivity and specificity between DB loaded and EX loaded test \ Conclusion\ Both the DB and EX loaded test will increase the sensitivity of CHD,but not increase the false positive rate Drug loaded test was a good choice to the patients who were unfit for EX load test