门控心肌灌注显像在经皮冠状动脉介入治疗中的临床价值

Assessment of the value of the gated myocardial perfusion imaging in percutaneous coronary intervention

目的探讨99Tcm-甲氧基异丁基异腈（MIBI）腺苷负荷门控心肌灌注显像（G-MID在经皮冠状动脉介入治疗（PCI）术前后的l临床应用价值。方法对54例行PCI的冠心病患者，术前2周行99Tcm-MIBI腺苷负荷＋静息G—MPI，并随访6个月，于PCI术后1个月、6个月复查腺苷负荷＋静息G-MPI显像。采用左心室20个节段0～4分的5分制半定量评分方法，分别计算每个室壁节段的腺苷负荷评分（SS）及静息评分（RS），两者的差值为差分值（DS），用于评估缺血的程度。综合每个节段腺苷负荷-静息G—MPI的评分，将其结果分为可逆性缺血（RD）和固定缺损（FD）。采用SPSS11．5软件，计量资料行独立样本t检验，计数资料行x2检验。结果（1）PCI术前根据心肌显像灌注异常节段划分，共有435个节段异常（RD、FD分别为323和112个），术后1个月312个节段RD改善，62个节段FD改善，PCI术后1个月RD的改善率（96．59％）明显好于FD（55．36％），差异有统计学意义（x2=117．30，P〈0．01）；术后6个月有12个节段进一步改善（RD3个、FD9个），术后6个月RD改善较FD明显，两者差异有统计学意义（97．52％与63．39％，x2=96．919，P〈0．01）。（2）PCI术前RD、FD的SS分别为3．31±0．624和3．64±0．487，术后1个月分别为1．69±0．668和3．14±0．683，术后6个月分别为1．39±0．728和3．03±0．506，术前与术后1个月RD、FD的SS差异有统计学意义，t=10．569，2．348，P均〈0．05；术前与术后6个月RD、FD的SS差异有统计学意义，t=11．991，2．720，P均〈0．05；术后1个月与术后6个月RD、FD的sS差异无统计学意义，t=1．885，0．784，P=0．068，0．435。结论G-MPI对PCI术有一定的指导意义并可较好地评价PCI术疗效。

Objective To investigate the clinical value of 99Tcm-methoxyisobutylisonitrile （MIBI） adenosine （ADE） stress gated myocardial perfusion imaging （G-MPI） during percutaneous coronary intervention （PCI）. Methods Fifty-four coronary heart disease （CHD） patients had the ADE stress and rest G-MPI at two weeks before, and 1 month, 6 months after PCI. A semi-quantitative visual analysis using a 20-segment and 5-point scoring system was used in both stress （SS） and rest （RS）. SPSS 11.5 was used for data analysis. The measurement data were performed with the independent samples t-test and enumeration data withx2-test. Results （1） Segmental based analyses, a total of 435 abnormal segments were found before PCI： 323 were reversible defect （RD） and 112 were fixed defect （FD）. One month after PCI, 374 segments improved. Three hundred and twelve were RD and 62 were FD （96.59% vs 55.36%, X2 = 117.30, P 〈0. 01 ）. An additional 12 segments were improved 6 months after PCI. Three were RD and 9 were FD （97.52% vs 63.39%, x2=96.919, P 〈 0.01 ）. （2） There was significant difference of SS in RD and FD in patients before and one month after PCI （3.31 ± 0.624 vs 1.69 ±0. 668, t = 10. 569, P 〈 0. 05 and 3.64 ±0. 487 vs 3.14 ±0. 683, t = 2. 348, P 〈 0. 05 ）, and before and six months after PCI （3.31 ±0.624 vs 1.39 ±0.728, t =11.991, P〈0.05 and 3.64 ±0.487 vs 3.03 ±0.506, t =2. 720, P〈 0. 05）, respectively. No significant difference was noted at one month and six months after PCI （ 1.69 ± 0.668 vs 1.39 ±0. 728, t = 1. 885, P = 0. 068 and 3.14 ± 0. 683 vs 3.03 ± 0. 506,,t = 0. 784, P = 0. 435）, respectively. Conclusion G-MPI can provide useful information to predict outcome of PCI at one month after intervention.