药物负荷心肌灌注显像评价心脏X综合征的应用研究

Clinical utiligy of pharmacological stress myocardial perfusion imaging in cardiac syndrome X

目的:对比双嘧达莫负荷心肌铊-201(201 Tl)单光子发射计算机断层摄影(SPECT)和多巴酚丁胺负荷心肌99m锝-甲氧基异丁基异腈(99mTc-MIBI)SPECT显像在辅助诊断心脏X综合征中的应用。方法:将74例心脏X综合征患者按不同的负荷药物分成A、B两组,其中A组行双嘧达莫负荷心肌201 Tl SPECT显像,B组行多巴酚丁胺负荷心肌99mTc-MIBI SPECT显像。原始图像经三维重建后由2位以上有经验的核医学科医师进行分析。两组阳性率之间的比较采用卡方检验。结果:A组53例患者负荷显像均正常,静息显像有45例出现"反向再分布",其余8例静息显像正常,阳性率为84.91%(45/53)。B组21例患者有3例出现可逆性缺损,其余18例负荷和静息显像均正常,阳性率为14.29%(3/21)。两组阳性率比较有统计学差异(χ2=29.89,P<0.001)。结论:双嘧达莫负荷心肌201 Tl SPECT显像的"反向再分布"现象对心脏X综合征具有一定的诊断价值。

Objective： To evaluate the comparative value of dipyridamole ^201T1 single photon emission computer tomgraphy （SPECT） cardiac perfusion imaging and dobutamine ^99mTc-MIBI SPECT imaging in cardiac syndrome X （CSX）. Methods： A cohort of seventy-four patients with known CSX who had undergone pharmacological stress myocardial perfusion imaging in our hospital from March 2005 to April 2012 were reviewed. The CSX patients were assigned to group A and group B according to different pharmacological stress agents. Group A underwent dipyridamole ^201 T1 SPECT cardiac imaging and group B underwent dobutamine ^99mTc-MIBI SPECT imaging. Images were interpreted by more than two experienced nuclear medicine physicians. Comparisons of the categorical variables between the two groups were performed using χ2 test for positive rates. Results： In group A, reverse redistribution phenomena were observed in 45 cases, while the remaining 8 had normal cardiac imaging. In group B, only 3 cases had reversible defect. The positive rates were 84.91%（in group A, 45/53）and 14.29% （in group B,3/21）, respectively. There was statistically significant difference in positive rate between the two groups （χ2 = 29.89, P〈0. 001 ）, Conclusion： Reverse redistribution in dipyridamole 201 T1 SPECT cardiac imaging may be of some value for the assessment of patients with CSX.