ATP-MPI在心脏X综合征患者冠状动脉血流储备评价中的应用

Application of adenosine triphosphate stress myocardial perfusion imaging to coronary flow reserve evaluation in patients with cardiac syndrome X

目的探讨腺苷三磷酸负荷心肌灌注显像(ATP-MPI)在评价心脏X综合征患者冠状动脉血流储备(CFR)中的价值。方法选择心脏X综合征患者42例(心脏X综合征组),其中男12例,女30例;健康者16例(对照组),其中男7例,女9例。分别行静息态及ATP负荷心肌灌注断层显像(MPI)。结果心脏X综合征组呈缺血性改变27例(64.3%),对照组1例(6.2%),两组比较,差异有统计学意义(χ2=15.6,P<0.01);心脏X综合征组共378个节段,其中82个节段(21.7%)呈放射性异常分布;对照组共144个节段,其中2个节段(1.4%)呈放射性异常分布,两组比较,差异有统计学意义(χ2=31.8,P<0.01)。心脏X综合征组ATP负荷前后对照:静息态MPI呈缺血性改变5例(11.9%),ATP负荷后呈缺血性改变27例(64.3%),二者比较,差异有统计学意义(χ2=20.0,P<0.01);静息态呈放射性异常分布8个节段(2.1%),ATP负荷后呈放射性异常分布82个节段(21.7%),二者比较,差异有统计学意义(χ2=74.0,P<0.01)。心脏X综合征组12例男性患者中MPI呈缺血性改变7例(58.3%),30例女性患者中呈缺血性改变20例(66.7%),两组比较,差异无统计学意义(χ2=0.02,P>0.05);男性患者共108个节段,其中19个节段(17.6%)呈放射性异常分布,女性患者共270个节段,其中63个节段(23.3%)呈放射性异常分布,两组比较,差异无统计学意义(χ2=1.5,P>0.05)。结论心脏X综合征患者冠状动脉微循环功能明显异常,ATP-MPI可评价心脏X综合征患者CFR能力。

Objective To investigate the value of adenosine triphosphate stress myocardial perfusion imaging （ATP- MPI） by 99Tcm-methoxyisobutyl isonitrile （MIBI）single photon emission computed tomography （SPECT） on evaluating the coronary flow reserve （CFR） in the patients with cardiac syndrome X （CSX）. Methods 42 patients with （CSX） were enrolled in this study, including 12 males and 30 females. 16 normal individuals were selected as control. All cases received stress-rest MPI and ATP- MPI by 99Tcm-M1BI. Results 27 cases （64.3%） revealed the ischemia change in the CSX group,while only 1 case （6.2%） in the control group, the difference between the two groups showing statistical significance （X2=15.6, P〈0.01 ）. Among 378 segments in the CSX group, 82 segments （21.7%） showed radioactive abnormal distribution ,while among 144 segments in the control group, 2 segments （1.4%） showed radioactive abnormal distribution, the difference between the two groups showing statistical significance （X2=31.8 ,P〈0.01 ）. In the CSX group, stress-rest MPI showed 5 cases （11.9% ） of ischemic change, while 27 cases （64.3%） were found with ischemic change by ATP-MPI, the difference between them showing statistiscal significance 0（：=20.0,P〈0.01 ）. 8 seg ments （2.1%） by stress-rest MPI and 82 segments by ATP-MPI demonstrated radioactive abnormal distribution with statistical dif- ference between them （X2=74.0 ,P〈0.001 ）. Among 12 males in the male subgroup and 30 females in the female subgroup, MPI showed ischemic change in 7 males （58.3%） and 20 females （66.7%） without statistical difference （X2=0.02,P〉0.05）. The male subgroup had 108 segments, in which 19 segments （17.6%） showed the radioactive abnormal distribution, the female subgroup had 270 segments ,in which 63 segments（23.3%） showed the radioactive abnormal distribution ,there was no statistical difference between them （X2= 1.5, P〉0.05 ）. Conclusion Myocardial microcirculation function is obviously abnormal in CSX, ATP-MPI is useful for assessing CFR in the patients with CSX.