腺苷负荷心肌灌注显像对冠状动脉介入治疗的临床意义

Clinical Value of Adenosine ^(99m)Tc-MIBI Myocardial Perfusion Single Photon Emission Computed Tomography in Percutaneous Coronary Intervention

目的:探讨腺苷负荷心肌灌注显像对冠状动脉(冠脉)介入治疗的临床意义。方法:66例冠心病患者,行腺苷负荷心肌灌注显像和冠脉造影,根据需要进行介入治疗,介入治疗后3～7天复查腺苷负荷心肌灌注显像。腺苷负荷心肌灌注显像采用单光子发射断层显像图像采集系统,腺苷注射液总量为840μg/kg,6分钟匀速静脉泵入,腺苷泵入3分钟时静脉推注99锝-2-甲氧基异丁基异腈核素(99mTc-MIBI);1.5h后进行心肌灌注断层显像。若异常,次日行静息心肌显像。核素显像左心室心肌分为9个节段,心肌灌注评分分4级。结果:66例患者的腺苷负荷心肌灌注显像与冠脉造影结果相比,双支病变腺苷负荷心肌灌注显像阳性率(87.5%,28/32)和三支病变腺苷负荷心肌灌注显像阳性率(100%),与冠脉造影阳性率(100%)比较差异均无统计学意义(P>0.05);单支病变腺苷负荷心肌灌注显像阳性率为54.5%(12/22),与冠脉造影阳性率(100%)比较差异有统计学意义(P<0.01)。双支病变和三支病变腺苷负荷心肌灌注显像阳性率分别与单支病变相比,差异均有统计学意义(P均<0.05)。冠脉介入后心肌核素显像血流灌注改善率为94.1%(32/34),与冠状动脉介入前(0%,0/34)自身对照,差异有统计学意义(P=0.003)。结论:腺苷负荷心肌灌注显像对于冠心病患者冠脉介入前病变程度分析以及介入后疗效判断有一定的临床意义。

Objective：To analyze the clinical value of adenosine 99mTc-MIBI myocardial perfusion single photon emission computed tomo- graphy （SPECT） of patients with coronary artery disease （CAD） in percutaneous coronary intervention （PCI）. Methods：Coronary angiography and Adeno,~ine 99mTc-MIBI myocardial perfusion SPECT were conducted in 66 patients, PCI was performed as needed. SPECT re-examination was applied after PCI. Adenosine was infused intravenously for a total of 840 Ixg/kg in 6 minutes, and 99mTc-MIBI was injected intravenously at 3 minutes after adenosine infusion SPECT. Myocardial ima- ging acquisition was obtained 1.5 hours after adenosine infusion. If abnormality was found, the rest 99mTc-MIBI myocardial perfu- sion SPECT would be performed next day. As indicated by SPECT imaging,left ventricle was divided into 9 segments, and myocar- dial perfusion was classified for 4 degrees. Results ：SPECT imaging indicated that the positive finding for two branch lesion was 87. 5% （28/32） ,for three branch lesion was 100% ,which was the same as coronary angiography. While the positive finding for a single branch lesion was 54. 5% （12/ 22） by SPECT, it was 100% by coronary angiography（ P 〈 0. 01 ）. Compared with single branch lesion, the positive findings by SPECT for two branch lesion and for three branch lesion were much higher,P 〈 0. 05 respectively. 34 patients received SPECT re- examination after PCI, and 94. 1% of them had the improved myocardial infusion （ Post-PCI, 32/34, vs. Pre-PCI, 0/34, P = O. 003）. Conclusion：Adenosine 99mTc-MIBI myocardial perfusion SPECT had the certain effect for evaluating the coronary artery le- sions in CAD patients before and after PCI in clinical practice.