^(99)Tc^m-MIBI门控心肌显像测定局部室壁收缩增厚率对冠心病的诊断价值

The diagnostic value of regional systolic thickening rate measured by ^(99)Tc^m-MIBI gated myocardial tomography on coronary artery disease

目的 探讨心肌局部室壁收缩增厚率 (STR)与心肌局部室壁运动状态和冠状动脉 (简称冠脉 )狭窄程度间的关系及其临床意义。方法 对 34例冠心病 (CAD)患者和 8例正常受检者行静息99Tcm 甲氧基异丁基异腈 (MIBI)门控心肌断层显像。根据冠脉和左室造影所得冠脉狭窄程度和运动状态分组。取收缩末期和舒张末期图像计算STR值。结果 对照组和CAD无室壁运动异常组与室壁运动减弱组、无室壁运动组及矛盾运动组之间的STR值差异均有显著性 (P <0 .0 1或P <0 .0 5 ) ;对照组与冠脉轻度、中度、重度狭窄节段之间STR差异均有显著性 (P <0 .0 1或P <0 .0 5 ) ,且STR与该节段供血冠脉狭窄程度呈负相关 (r =- 0 .74,P <0 .0 1)。STR判定室壁运动异常的灵敏度为77 9% ,特异性为 90 .9% ;判断冠脉中度以上狭窄 (冠脉狭窄 >5 0 % )和重度狭窄 (冠脉狭窄 >80 % )的灵敏度分别为 5 3.8%和 73.4% ,特异性分别为 93.1%和 88.9%。

Objective To explore the relationship among the regional systolic thickening ratio (STR) measured by rest 99Tcm-MIBI gated myocardial tomography, regional wall motion state and the order of severity of supplying coronary artery stenosis. Methods Rest 99Tcm-MIBI gated myocardial tomography was performed on 34 cases with coronary artery disease and 8 normal subjects. Groups were divided according to the different order of severity of coronary artery stenosis and regional wall motion state, then the differences of STR among the groups were compared and the clinical value was assessed. Results As to STR value, there were significant differences between the control group、 CAD with normal wall motion group and the CAD group of different wall motion state (P<0.01 or P<0.05); there were significant differences between the groups of the control group and CAD group whose supplying artery appeared stenosis≤50%, that>50% but≤80% and that>80% (P<0.01 or P<0.05). The STR value showed the negative correlation with the order of severity of the supplying coronary artery stenosis (r=-0.74,P<0.01). The sensitivity of STR for identifying the abnormal wall motion segments was 77.9%, the specificity was 90.9%; the sensitivities for identifying the segments whose supplying artery appeared stenosis>50%、 stenosis>80% were 53.8% and 73.4%; the specificities were 93.1% and 88.9%, respectively. Conclusions Gated myocardial tomography is a simple-to-use and non-invasive technique. It can identify the regional wall motion state and the order of severity of the supplying coronary artery stenosis by means of STR measurement which is a quantitative parameter in common use until now for observing the myocardial blood perfusion.