^(99m)Tc-MIBI心肌灌注显像在川崎病心肌缺血诊断及疗效判断中的价值

The Value of ^(99m)Tc-MIBI Myocardial Perfusion Imaging in Detecting Myocardial Ischemia and Judging Treatment in Patients with Kawasaki Disease

目的探讨99mTc-MIBI(甲氧异腈)静息心肌灌注显像在川崎病心肌缺血及疗效评价中的临床价值。方法 41例川崎病根据病程分为急性发热期、亚急性期和恢复期3组。对照组8例系怀疑川崎病患儿,后经实验室检查排除川崎病和其他心肌疾病者。两组病例均行99mTc-MIBI静息心肌灌注显像,阳性者于治疗后6～12个月随访复查,并与其临床转归进行比较。结果对照组静息心肌灌注显像未见异常。41例川崎病患儿静息心肌灌注显像阳性率为39.02%(16/41)。其中急性期、亚急性期和恢复期患儿的阳性率分别为36.84%(7/19)、41.67%(5/12)和40%(4/10)。10例显像阳性者经治疗后6～12个月行静息心肌灌注显像复查,缺血明显改善5例,恢复正常4例,1例仍见明显心肌缺血。结论 99mTc-MIBI静息心肌灌注显像能无创、直接、客观地评价川崎病心肌缺血的部位、范围和程度,对川崎病心肌缺血的诊断和随访有一定的临床价值。

Objective 99mTc-MIBI myocardial perfusion imaging was undertaken to detect myocardial ischemia in children with Kawasaki disease in order to evaluate its diagnostic value.Methods The subjects included 41 children with Kawasaki disease.The control group included 8 children without cardiovascular disease.The 41 patients were classified into three groups by their clinical manifestations： acute phase（n=19）,sub-acute phase（n=12）,and chronic phase（n=10）.All patients undertaken 99mTc-MIBI myocardial perfusion SPECT imaging.The 10 patients with positive SPECT repeated their SPECT imaging from 6 to 12 months later.Results In the control group normal SPECT imaging was performed.Sixteen of 41（39.02%） patients were positive in perfusion imaging.The positive rates in acute phase,sub-acute phase and chronic phase were 36.84%（7/19）,41.67%（5/12） and 40%（4/10）.Ten patients with positive perfusion imaging had SPECT imaging again from 6 to 12 months later,5 were normal,4 improved significantly,only 1 unchanged.Conclusion 99mTc-MIBI myocardial perfusion imaging is a useful noninvasive method for diagnosis evaluation of myocardial ischemia in Kawasaki disease.