冠状动脉介入治疗和药物治疗前后心肌显像比较

Comparison of ^(99)TC-NOET myocardial perfusion imaging between PCI and routine pharmacotherapy in elderly patients with coronary artery disease

目的前瞻性观察冠状动脉介入治疗(PCI)和常规药物治疗前后,甲氧异腈心肌显像及核素心室显像的结果和差异,并探讨其临床应用价值。方法根据冠状动脉造影的狭窄程度,将121例冠心病患者按狭窄70%～85%分为轻度组(36例),狭窄>85%为重度组(33例),患者不愿行PCI或狭窄<70%为对照组(52例),均按照冠心病指南的标准治疗1年后,分别复查单光子发射计算机断层显像,对比治疗前后的心肌缺血情况。结果与治疗前比较,3组治疗后缺血节段数﹑运动低下节段数﹑左心室射血分数均有明显改善(P<0.01),与轻度组、对照组和自身治疗后指标对比,重度组差异有统计学意义(P<0.05,P<0.01),但轻度组与对照组治疗后比较,差异无统计学意义(P>0.05)。轻度组、重度组缺血加重比例均比对照组少。结论急性严重心绞痛或不稳定性心绞痛﹑或疑为急性心肌梗死且在时间窗内的冠心病患者,PCI对改善缺血心肌﹑心功能和缓解症状,提高生存率和预后有明显效果,但对狭窄程度轻﹑病变广泛﹑危险因素多或错过时间窗,或合并糖尿病,尤其是高龄冠心病患者,综合治疗也许是较好的选择。不论何种冠心病,心肌灌注显像检查对于疗效﹑再狭窄﹑侧支循环和生存率判定非常必要且重复易行。

Objective To evaluate the clinical application of 99TC-NOET myocardial perfusion imaging（MPI）between percutaneous coronary intervention（PCI）and routine pharmacotherapy in elderly patients with coronary artery disease（CAD）before and after PCI.Methods According to degree and value of coronary arteriography（CAG）,121 elderly patients with CAD were randomly assigned as mild group to be with coronary artery stenosis 70～85 percent（n=36）,as severe group to be with coronary artery stenosis≥85 percent（n=33）and as control group to be with coronary artery stenosis 70 percent or non-PCI（n=52）.According ACC Guideline,all patients were treated for one year and performed MPI respectively before and after treatment.Results Left ventricular ejection fraction（LVEF）,segments of ischemia and myocardial hypoactivity were significantly improved and had differences than that before study in all groups（P0.05）.About all indexes after treatments,there were significant differences in severe group compared to other groups and itself（P0.05 or P0.01）.But there were no differences in mild group than that in control group（P0.05）.Ischemia had less deterioration in PCI group than that in control group.Conclusions PCI seems to be more effective in improving myocardial ischemia,function,clinical symptoms,prognosis and survival rate within 6 or 8 hours.Except PCI,general treatments is a better choice for patients with mild stenosis,extensive ischemia,more risk factors,delay hospital or combined diabetes mellitus（DM）,especially elderly senile patients.99TC-NOET MPI is an important and repeated examination in the judgment of effectiveness,restenosis,collateral branch circulation and survival rate for all patients with CAD.