高血压患者^(99)Tc^m-MIBI负荷心肌灌注断层显像异常的临床意义

The clinical significance of abnormal ^(99)Tc^m-MIBI myocardial perfusion tomography in patients with hypertension

目的 探讨心肌灌注显像异常对冠状动脉造影 (CAG)正常的高血压患者的临床意义。方法 应用99Tcm 甲氧基异丁基异腈 (MIBI)负荷与静息心肌灌注断层显像 (MPT)定性方法 ,及侧壁 间隔计数比值 (L S)和负荷L S与静息L S之再比值 ,比较了 2 1例CAG正常的高血压患者与 11例血压正常的对照者的结果。结果 ①高血压组MPT阳性率为 6 1 9% ,显著高于对照组的 9 1% ,P <0 0 1,且以可逆性缺损为主 ,伴有少数反向填充 ;其心绞痛与心律失常发生率也明显高于对照组。②高血压组与对照组相比 ,负荷L S与静息L S之再比值明显降低 ,P <0 0 5。③高血压组MPT阳性患者负荷L S与静息L S之再比值低于MPT阴性患者 ,P <0 0 1;MPT阳性者烟酒嗜好明显多于MPT阴性者 ,分别为 5 3 8%和 12 5 % ,P <0 0 5。④MPT异常分布于各个节段 ,大多数无明显心肌肥厚表现。结论 ①心肌灌注显像异常可以发生在CAG正常、有或无心肌肥厚的高血压患者中。②长期烟酒嗜好是高血压患者出现心肌缺血的危险因素之一。

Objective To evaluate the clinical significance of abnormal myocardial perfusion tomography in the hypertensive patients with normal coronary angiography Methods Qualitative diagnosis,the average counts ratio of lateral to septal segments (L/S) and the ratio of stress L/S to rest L/S from stress and rest 99 Tc m sestamibi myocardial perfusion tomography (MPT), and every clinical characteristic and the results from other examinations were compared between hypertensive patients (HP) and normotensive controls (NC) Every risk factor leading to coronary artery disease and related indexes in patients with positive MPT were compared with the results of patients with negative MPT Results ①The positive rate of MPT in HP was obviously higher than that of NC,which was 61 9% vs 9 1%, respectively Most focuses of MPT were reversible defects (RD), a few of them accompanied by reverse reversible defects (RRD) There were many more angina pectoris and heart arrhythmia attacks in HP than in NC ②The ratio of stress L/S to rest L/S of HP was lower than that of NC (P<0 05) ③The ratio of stress L/S to rest L/S of the patients with positive MPT in HP significantly decreased compared with that of the patients with negative MPT (P<0 01) There were more patients being addicted to smoking and drinking in those with a positive than in those with a negative MPT (53 8% versus 12 5%, P<0 05) ④The abnormal defects of MPT in HP were almost seen in any segment of left ventricle and most of the patients had no left ventricular hypertrophy, but did smoke and drink Conclusions ①Abnormal MPT exist in the HP with normal coronary angiography and not necessarily with left ventricular hypertrophy ②The long term addiction of smoking and drinking was one of the risk factors leading to arouse myocardial ischemia in HP