腺苷负荷99Tcm—MIBI心肌显像在冠状动脉造影慢血流患者中的应用

99Tcm-MIBI adenosine myocardial perfusion imaging in patients with slow coronary flow

目的探讨腺苷负荷99Tcm-甲氧基异丁基异腈（MIBI）心肌显像与冠状动脉（简称冠脉）造影慢血流现象的关系。方法44例患者均经冠脉造影及腺苷负荷99TcmMIBI心肌血流灌注显像，分析比较冠脉造影阳性组（P—CAG）12例，冠脉慢血流组（CSF）22例以及冠脉正常血流组（NCF）10例患者临床资料、腺苷心肌负荷显像改变、冠脉造影结果与腺苷负荷心肌显像的关系。结果采用方差分析、t检验或X^2检验比较。结果3组临床资料（包括年龄、性别和危险因素：高血压史、高脂血症及糖尿病发病率）差异均无统计学意义（年龄：t=0．27，0．54和0．59；性别：矿：0．92；危险因素：X^2=1．23；P均〉0．05）；CSF组冠脉心肌梗死溶栓疗法（TIMI）血流帧数明显多于NCF组（33．7±5．5和17．6±3．9，t=-9．58，P〈0．001）。P—CAG组12例，腺苷负荷心肌显像阳性率100％（12／12）；CSF组22例，阳性率77．3％（17／22）；NCF组10例，2例阳性。半定量靶心图分析示腺苷负荷试验心肌缺血范围（人均缺血节段数）CSF组多于NCF组（1．06±0．77和0．91±0．80，t=-2．02，P〈0．05），少于P—CAG组（2．41±0．79，t=4．54，P〈0．001）。靶心图记分心肌缺血程度显示CSF组大于NCF组（8．01±6．06和2．73±2．60，t=-2．07，P〈0．05），小于P—CAG组，但差异无统计学意义（14．07±12．77，t=1．44，P〉0．05）。结论腺苷负荷心肌灌注阳性显像中部分患者伴有冠脉造影慢血流现象，这为有明显胸痛症状但冠脉造影阴性的患者提供了诊断和治疗依据。

Objective To investigate the relationship between myocardial ischemia and slow coronary flow phenomenon with 99Tcm-methoxyisobutylisonitrile （MIBI） adenosine myocardial perfusion SPECT imaging. Methods Forty-four patients were divided to three groups according to the result of coronary angiography（CAG）. There were CAG-positive（P-CAG） （ n = 12）, slow coronary flow （CSF） （ n = 22）, and normal coronary flow （NCF） （n = 10）. Results of adenosine myocardial perfusion imaging were compared among these three groups. Semi-quantitative visual scoring method was used to evaluate the myocardial perfusion： 0 = normal, 1 = mild decrease, 2 = moderate decrease, 3 = severe decrease ,4 = defect. Statistical analysis was performed using variance analysis, t-test and x2-test. Results No significance was observed at age （ t = 0. 27, 0.54 and 0.59）, sex （X2 = 0. 92）, hypertension, hypedipemia and diabetes （X2 -1.23, all P 〉 0.05 ） among the three groups. A significantly higher frames of the coronary thrombolysis in myocardial infarction （TIMI） flow was noted in CSF than in NCF groups （33.7 ± 5.5 vs 17.6 ± 3.9, t = - 9.58, P 〈0.001 ）. The positive adenosine myocardial perfusion imaging rate were significant among these three groups with 100% （12/12） in P-CAG group, 77.3% （17/22） in CSF group, and 20% （2/10） in NCF group. When using semi-quantitative visual scoring method, significantly higher average ischemia segments were noted in CSF group than in NCF group （ 1.06± 0.77 and 0.91± 0.80, t = - 2. 02, P 〈 0.05 ）, but was less than that in P-CAG group （2.41 ± 0.79, t = 4. 54, P 〈 0. 001 ）. The degree of ischemia of CSF group was higher than that in NCF group （8.01 ±6.06, and 2.73±2.60, t = -2. 07, P 〈0.05） and was less than that in P-CAG group （ 14.07 ± 12.77, t = 1.44, P 〉 0.05 ）. Conclusion Slow coronary flow phenomenon can be detected by adenosine myocardial perfusion image to offer the evidence of diagnosis and treatment for the chest pain patients with negative coronary angiography results.