门控心肌灌注显像对冠状动脉粥样硬化性心脏病的诊断及评估价值

Value of gated myocardial perfusion imaging in diagnosis and estimation of coronary atherosclerotic heart disease

目的探讨门控心肌灌注显像(gated myocardial perfusion imaging,GMPI)对冠状动脉粥样硬化性心脏病(冠心病)的诊断及评估冠状动脉病变程度的价值。方法对2012年来我科就诊的60例临床疑似冠心病患者行门控运动静息心肌灌注显像,在行门控心肌灌注显像1周内行冠状动脉造影(coronary angiography,CAG)等检查。观察左心室各室壁的心肌血流灌注情况,利用半定量分析法得出门控心肌灌注显像的半定量评分,并与冠脉狭窄节段Gensini(GS)积分进行相关性分析。结果 1)GMPI检测冠心病的灵敏度、特异度及准确性分别为93.33%、80.00%、90.00%。2)GMPI检测单支、双支和三支病变的敏感性分别为75.00%、82.35%、93.75%,三组间差异有统计学意义(χ2=21.794,P<0.01)。3)CAG显示45例共94支血管异常,其中轻度狭窄34支,中度狭窄38支,重度狭窄22支。GMPI检测三种狭窄程度血管的敏感性分别为76.47%、86.84%、95.45%(χ2=98.55,P<0.01)。4)GMPI半定量评分随GS积分升高逐渐升高。相关分析显示,相关系数分别为轻度狭窄0.751、中度狭窄0.816、重度狭窄0.857(P<0.01)。结论门控心肌灌注显像对冠心病的诊断具有重要价值。心肌灌注缺损的严重程度与冠脉病变程度具有显著正相关。

Objective To study the value of gated myocardial perfusion imaging （GMPI） in diagnosis and estimation of coronary atherosclerotic heart disease. Methods Sixty patients with suspected coronary heart disease （CHD） admitted to our department in 2012 underwent GMPI and coronary angiography （CAG） and other tests 1 week after GMPI to observe their left ventricular myocardial perfusion. Semi-quantitative score of GMPI was recorded by semi-quantitative analysis and its correlation with coronary Gensini score （GS） was analyzed. Results The sensitivity, specificity and accuracy of GMPI in diagnosis of CHD were 93.33%, 80.00% and 90.00%, respectively. The sensitivity of GMPI in diagnosis of single lesion, double lesions and triple lesions was 75.00% （9/12）, 82.35% （14/17） and 93.75% （15/16） , respectively （X 2=21-794, P 〈 0.01）. CAG showed 94 abnormal blood vessels in 45 patients. Of these 94 abnormal blood vessels, 34 showed mild stenosis, 38 showed moderate stenosis and 22 showed severe stenosis. The sensitivity of GMPI in diagnosis of the 3 kinds of stenosis was 76.47% （26/34）, 86.84%（33/38）, and 95.45% （21/22）, respectively （X 2=98.55, P 〈 0.01）. The semi-quantitative score of GMPI increased with the coronary GS. Pearson correlation analysis showed that the correlation coefficient of mild stenosis, moderate stenosis, and severe stenosis was 0.751, 0.816, and 0.857, respectively （P 〈 0,01）. Conclusion GMPI plays an important role in diagnosis of CHD. The severity of myocardial perfusion injury is positively related with the severity of CHD.