症候学结合核素心肌灌注显像诊断心肌炎的临床研究

Study on combined clinical manifestation and myocardial perfusion imaging with 99m Tc MIBI SPECT for diagnosing myocarditis

对有心功能损害、心律失常、胸痛及／ 或心前区紧压感等症候一种以上，且一月内有带咽痛的上呼吸道感染史的患者５６８ 例，作９９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ 心肌灌注断层显像。结果表明，有４０４ 例（７１１２ ％ ） 支持临床对心肌炎的诊断。另１０８ 例患者一月内仅有咽痛的上呼吸道感染史，其中６ 例（５５ ％ ） 其核素心肌灌注显像支持心肌炎，其血清柯萨奇 Ｂ 组病毒 Ｉｇ Ｍ 抗体呈阳性，诊断为病毒感染所致心肌反应，一月后有３ 例出现心律失常。症候学结合核素心肌灌注显像表现是诊断心肌炎有效的方法。

In 568 cases suffering from upper respiratory tract infection with sore throat and more than one of following clinical manifestations: arrhythmia, heart failure and chest pain or oppressive sensation over the chest(Group A), and another 108 cases without above clinical manifestations(Group B), myocardial perfusion imaging with 99m Tc MIBI SPECT was studied. The results revealed that the imaging in 404 cases(71.12%) of Group A supported diagnosis of myocarditis, but only 6 cases(5.56%) did so in Group B. Because of lacking the clinical manifestations of myocarditis but positive finding of CVB IgM antibody was detected in their sera, we considered that the positive SPECT imaging in these six cases of Group B belonged to myocardial reaction due to virus infection. It was possible that some of them were suffering from subclinical type of myocarditis.