核素显像在病毒性心肌炎诊疗中的意义

The value of nuclide myocardial scintigraphy for the clinical of acute viral myocarditis

目的 研究核素心肌灌注扫描 (ECT)与急性病毒性心肌炎诊疗和转归的相关性并探讨其诊疗意义。方法 48例急性病毒性心肌炎患者 ,其中 2 1例ECT异常为阳性组 ,正常为阴性组 ,两组资料进行统计学分析。结果 阳性组肌酸磷酸激酶同功酶、室性早搏次数和多源性心律失常、左室舒张功能减低等例数均比阴性组多 ,并具有统计学意义 ;阳性组治疗后复查ECT均基本正常 ;心律失常好转率明显高及随访复发率明显低于阴性组 ,并具有统计学意义。结论 ECT可作为急性病毒性心肌炎诊疗中一项科学性与可靠性较强的参考指标。

Objective To investigate the significance of nuclid myocardial scintigraphy (ECT) as a clinical method for guiding the diagnosis, thorapy and prognosis of a cute viral myocarditis. Methods 48 patients with acute viral myocarditis were divided into two groups, 21 patients with ECT showing diffuse myocardial perfusion defect constituted a positive group and the remaining 27 with normal ECT a negative group. The relationship between the clinical data and treatment effect in the two groups were analyzed. Results In the positive group, CK-MB in 57.14% of the patients was higher than normal and 71.43% of the patients had ventricular premature beats (VPB) and atrial premature beats (APB). The average number of VPB per 24 hour was (4 228±1 506)beats. In the negative group, the values of the above items were 33.33%,44.44% and (2 268± 924 )beats. The difference between the two groups was statistically significant (all of P <0.01). After treatment of acute viral myocarditis, ECT of all the patients in the positive group returned to normal completely 85.71% of the patients with premature beats recovered from the arrhythmia. 38.10% of the patients with premature beats had arrhythmia again during a follow-up of 4 years. However, in the negative group, only 59.26% of the patients with premature beats recovered from the arrhythmia and 66.67% had arrhythmia again during the 4 years. The therapeutic effect between the two groups was also statistically different (all of P <0.01). Conclusion Up to now, there has been no unified diagnostic standard for acute viral myocarditis, so ECT may be an exact and reliable diagnostic method for acute viral myocarditis. It may help to avoid error in diagnosis, waste in health resources and side effects of the medications.