ATP负荷^99Tc^m—MIBI门控心肌灌注显像在评价冠状动脉支架植入术后再狭窄中的应用价值

ATP stress ^99Tc^m-MIBI gated myocardial perfusion imaging in diagnosis of in-stent restenosis

目的探讨ATP负荷^99Tc^m-MIBIG—MPI在评价冠状动脉（简称冠脉）支架植入术后再狭窄中的应用价值。方法选择71例冠脉支架植入术后3个月以上且伴有典型心绞痛症状的患者[男56例，女15例，年龄37～83（60．2±9．5）岁]进行前瞻性研究，于1个月内分别行ATP负荷^99Tc^m-MIBIG—MPI和CAG检查。以CAG作为“金标准”，评价ATP负荷^99Tc^m-MIBIG．MPI诊断冠脉支架植入术后再狭窄的诊断效能。应用SPSS17．0软件，采用Fisher确切概率法进行组间比较。结果71例患者中5例患者出现新发狭窄，予以剔除；66例患者共99支冠脉接受支架植入术，其中39例患者的45支冠脉出现再狭窄。39例中心肌梗死19例，非心肌梗死20例；另27例无再狭窄者中心肌梗死16例，非心肌梗死11例。ATP负荷^99Tc^m-MIBIG—MPI诊断冠脉支架植入术后再狭窄的Se、sp、Ac、PPV及NPV分别为：85％（33／39）、89％（24／27）、86％（57／66）、92％（33／36）及80％（24／30）；诊断心肌梗死组的相应效能为：79％（15／19）、88％（14／16）、83％（29／35）、88％（15／17）、78％（14／18），非心肌梗死组为：90％（18／20）、91％（10／11）、90％（28／31）、95％（18／19）、83％（10／12），2组间差异均无统计学意义（均P〉0．05）。结论ATP负荷^99Tc^m-MIBIG—MPI在评价冠脉支架植入术后再狭窄中具有较高的诊断效能，是一种安全价廉的检查方法。

Objective To investigate the value of ATP stress ^99Tc^m-MIBI G-MPI in evaluating instent restenosis. Methods Seventy-one patients （56 males, 15 females, age range： 37-83 （60.2±9.5） yeas） who had undergone coronary stent implantation at least 3 months ago, accompanying a typical angina pectoris symptom, were included in this perspective study. All patients underwent ATP stress ^99Tc^m-MIBI G- MP1 and CAG （gold standard） within 1 month. The diagnostic efficiency of ATP stress ^99Tc^m-MIBI G-MPI on in-stent restenosis was evaluated. Fisher exact probability method was used to analyze data with SPSS 17. 0. Results Five patients were excluded because of new stenosis. According to the results of CAG, 39 patients with 45 coronary arteries showed in-stent restenosis among 66 patients with 99 coronary arteries. There were 19 patients with myocardial infarction among the 39 patients with in-stent, restenosis. Contrarily,there were 16 patients with myocardial infarction among the 27 patients without in-stent restenosis. The diagnostic Se, Sp, Ac, PPV and NPV of ATP stress ^99Tc^m-MIBI G-MPI for in-stem restenosis were 85%（33/ 39）, 89% （ 24/27）, 86% （ 57/66 ）, 92% （33/36） and 80% （ 24/30）, respectively in 66 patients. Those were 79%（ 15/19）, 88%（ 14/16）, 83%（29/35）, 88%（15/17） and 78%（14/18） in patients with myocardial infarction, and 90% （ 18/20）, 91% （ 10/11 ）, 90% （ 28/31 ）, 95% （18/19） and 83% （10/12） in patients without myocardial infarction （all P〉0.05）. Conduslon ATP stress ^99Tc^m-MIBI G-MPI has high diagnostic efficiency in evaluating in-stent restenosis.