新型心肌灌注显像剂^99Tc^m-N-DBODC5诊断冠心病的临床价值

Clinical study of ^99Tc^m-N-DBODC5 as a novel myocardial perfusion imaging agent for the diagnosis of coronary artery disease

目的 探讨[二（二甲氧丙基膦基乙基）-乙氧乙胺]-[二（氧-乙氧乙基）二硫代氨基]锝氮配合物（^99Tc^m-N-DBODC5）对可疑冠心病患者的临床诊断价值.方法 将2010年10月至2012年10月间46例可疑冠心病患者[男31例,女15例,平均年龄60岁]按就诊先后顺序编号,同一患者随机分配进行^99Tc^m-N-DBODC5和^99Tc^m-MIBI运动-静息MPI检测冠心病及病变血管,2种显像剂的MPI在1周内完成,并在4周内行CAG.以CAG结果为“金标准”,^99Tc^m-N-DBODC5和^99Tc^m-MIBIMPI结果分别与其进行一致性检验,不同显像剂诊断效能的比较行χ^2检验.结果 46例可疑冠心病患者中,CAG阳性29例,阴性17例.^99Tc^m-N-DBODC5和^99Tc^m-MIBI MPI诊断冠心病的灵敏度均为86％ （25/29）,特异性分别为88％（15/17）和65％（11/17）,两者诊断冠心病效能差异无统计学意义（χ^2=2.62,P＞0.05）;138支冠状动脉血管中,CAG阳性48支,阴性90支.^99Tc^m-N-NDBODC5与^99Tc^m-MIBI MPI诊断病变血管效能差异也无统计学意义（χ^2=3.79,P＞0.05）.诊断冠心病方面,^99Tc^m-N-DBODC5 MPI与CAG结果的一致性较好（Kappa=0.73）,^99Tc^m-MIBI MPI与CAG结果的一致性中等（Kappa=0.52）.结论 ^99Tc^m-N-DBODC5对冠心病患者具有一定诊断价值,可作为心肌灌注显像剂应用于临床.

Objective To investigate the clinical value of ^99Tc^m-（bis（dimethoxypropylphosphinoethyl）-ethoxyethylamine）-（bis（N-ethoxyethyl）-dithiocarbamato nitride （^99Tc^m-N-DBODC5） for the detection of coronary artery disease （CAD）.Methods From October 2010 to October 2012,46 patients with suspected CAD （31 males,15 females; average age：60 years） were recruited.They all underwent stressrest MPI using both ^99Tc^m-N-DBODC5 and ^99Tc^m-MIBI within l week.CAG was carried out within 1 month after MPI and chosen as the gold standard.The diagnostic accordance rate between MPI and CAG were analyzed using Kappa test.The diagnostic efficiency of ^99Tc^m-N-DBODC5 and ^99Tc^m-MIBI MPI was compared byχ^2 test.Results Among the 46 patients,29 were positive and 17 were negative for CAD by CAG.The sensitivity and specificity in the detection of CAD were 86% （25/29） and 65% （11/17） for ^99Tc^m-MIBI MPI,86% （25/29） and 88% （15/17） for ^99Tc^m-N-DBODC5 MPI （χ^2=2.62,P〉0.05）,respectively.Among the 138 vessels,48 were positive and 90 were negative on CAG.The vessel-based sensitivity,specificity and accuracy for the detection of stenosis were not significantly different between ^99Tc^m-N-DBODC5 and ^99Tc^m-MIBI （χ^2=3.79,all P〉0.05）.The accordance between ^99Tc^m-N-DBODC5 MPI and angiography was very good （Kappa=0.73） and moderate for ^99Tc^m-MIBI MPI （Kappa=0.52）.Conclusion ^99Tc^m-N-DBODC5 might have a potential role as a MPI agent for the diagnosis of CAD.