^99Tc^m-替曲膦在冠心病诊断中的应用

Clinical application of ^99Tc^m-tetrofosmin in diagnosing patients with coronary heart diesase

目的探讨^99Tc^m-替曲膦（TF）在CHD诊断中的应用价值。方法回顾性分析2009年10月至2011年4月疑诊CHD并行^99Tc^m-TF或^99Tc^m-MIBI腺苷负荷-静息MPI的患者各40例，比较2种放射性药物心肌显像的心肺摄取比（H／L）。行^99Tc^m-TF显像的患者显像前后3个月内均行CAG，以冠状动脉狭窄≥50％为标准计算^99Tc^m．TF显像对CHD的诊断效能。对^99Tc^m-TF及”TcmMIBIH／L间差异行配对t检验，率的比较行X^2检验。结果^99Tc^m-TF心肌静息及负荷显像H／L分别为6．73±1．21及6．94±1．69，^99Tc^m-MIBI显像的相应值分别为6．58±1．94及6．64±1．81，2种显像方法H／L间差异无统计学意义（t=0．41和0．78，P均〉0．05），^99Tc^m-TF心肌静息及负荷显像H／L差异亦无统计学意义（t=0．69，P〉0．05）。40例患者中^99Tc^m-TF显像阳性24例（60．0％），对应病变血管45支，其中LAD20支，LCX11支，RCA14支。CAG阳性23例（57．5％，23／40），对应病变血管42支（LAD19支，LCX12支，RCA11支）。^99Tc^m-TF负荷-静息MPI的灵敏度、特异性、准确性、阳性预测值及阴性预测值分另0为87．0％（20／23）、76．5％（13／17）、82．5％（33／40）、83．3％（20／24）及81．2％（13／16）。以病变血管计，^99Tc^m．TFMPI对LAD、LCX及RCA血管病变诊断的灵敏度分别为89．5％（17／19）、83．3％（10／12）及90．9％（10／11）；阳性预测值分别为85．0％（17／20）、90．9％（10／11）及71．4％（10／14）。^99Tc^m-TF显像对不同血管病变的灵敏度和阳性预测值差异均无统计学意义（X^2=0．377和1．789，P均〉0．05）。结论从H／L可知，^99Tc^m-TF显像图像质量与^99Tc^m-MIBI显像接近；^99Tc^m-TF负荷-静息MPI是诊断CHD的可靠方法。

Objective To evaluate the diagnostic value of ^99Tc^m-tetrofosmin （TF） stress-rest MPI in detecting CHD. Methods Eighty patients with suspected CHD who had stress-rest MPI from October 2009 to April 2011 were retrospectively analyzed. Forty underwent 99Tem-TF （group A） and 40 received Clinical application of ^99Tc^m-MIBI （group B） stress-rest MPI. Heart/lung （H/L） ratios of these two groups were compared. CAG was performed on group A patients 3 months before and after MPI. Stenosis of more than 50% in CAG was used as a standard to evaluate the diagnostic efficiency of Clinical application of ^99Tc^m-TF MPI. Paired t test andX2 test were used to compare the data. Results H/L ratios of rest and stress from Clinical application of ^99Tc^m-TF images were 6.73 ± 1.21 and 6. 94 ± 1.69, while those from Clinical application of ^99Tc^m-MIBI images were 6.58 ±1.94 and 6.64 ±1.81, respectively. There was no difference between ^99Tc^m-TF and ^99Tc^m-MIBI imaging in both rest and stress （t =0.41,0.78, both P 〉 0.05 ）. There was no difference between H/L ratios from stress and rest Clinical application of ^99Tc^m-TF imaging （t = 0. 69, P 〉 0. 05）. Twenty-four patients who underwent Clinical application of ^99Tc^m-TF imaging had abnormal perfusion （60.0% , 24/40） , including 20 LAD, 11 LCX and 14 RCA. Twenty-three among these 40 patients had abnormal CAG results （57.5%, 23/40） , including 19 LAD, 12 LCX, and 11 RCA. The sensitivity, specificity, accuracy, posi- tive predictive value and negative predictive value of Clinical application of ^99Tc^m-TF stress-rest MPI were 87.0% （ 20/23 ） , 76. 5% （ 13/17）, 82.5% （33/40）, 83.3% （20/24） and 81.2% （ 13/16）, respectively. The sensitivitiesof Clinical application of ^99Tc^m-TF stress-rest MPI for detection of LAD, LCX and RCA were 89.5% （17/19）, 83.3% （10/12） and 90.9% （ 10/11 ）, respectively, and positive predictive values were 85.0% （ 17/20）, 90.9% （ 10/11 ） and 71.4% （10/14）, respectively. There was no significant difference for sensitivity and positive predictive value of ^99Tc^m-TF MPI among different vessels （X2 = 0. 377 and 1. 789, both P 〉 0.05 ）. Conclusions Clinical application of ^99Tc^m-TF MPI has comparative imaging quality to ^99Tc^m-MIBI MPI. Clinical application of ^99Tc^m-TF stress-rest MPI is a reliable method for detecting CHD.