慢性肾脏病患者腺苷负荷心肌灌注显像及肌钙蛋白水平的临床分析

Clinical Analysis of Adenosine 99 m Tc-MIBI Myocardial Perfusion Imaging and Cardiac Troponins I in Patients with Chronic Kidney Disease

目的分析腺苷负荷灌注心肌显像在慢性肾脏病患者缺血性心肌损害评估中的应用.方法收集非急性冠脉综合征的慢性肾脏病患者122例进行腺苷灌注心肌负荷显像检查,同时检测血肌酐、c Tn I、CK-MB、MYO,分析不同CKD分期的患者腺苷负荷试验结果,并与心肌钙蛋白水平进行对比研究.结果有31.1%的患者腺苷负荷试验阳性,其中心肌缺血患者占21.3%,心肌梗死患者占9.8%,84%的腺苷负荷试验阳性病例为CKD4期及CKD5期患者,无论是c Tn I还是CK-MB,无异常患者与心肌缺血及心肌梗死患者之间差异统计学意义(P<0.05).结论慢性肾脏病患者中,冠状动脉疾病的患病率明显升高,腺苷负荷核素心肌灌注显像是评估CKD患者缺血性心肌损害的有效手段,心肌钙蛋白的升高与腺苷负荷心肌灌注显像阳性结果之间密切相关,是心血管事件的预测因子.

Objective To explore the value of adenosine 99 m Tc- MIBI myocardial perfusion imaging in the assessment of ischemic myocardial damage for patients with chronic kidney disease（CKD）. Methods 122 CKD patients with non- acute coronary syndrome were collected and performed adenosine 99 m Tc- MIBI myocardial perfusion imaging examination. The serum creatinine, c Tn I, CK- MB and MYO were detected. The adenosine stress test results in patients with different stages of CKD were analyzed and compared with the levels of cardiac troponin I. Results 31.1% patients showed positive results in adenosine stress test, of which patients with myocardial ischemia and myocardial infarction accounted for 21.3% and 9.8%, respectively. There were 84% of patients with stages CKD4 and CKD5 in all positive cases. There were significant differences in CTn I or CK- MB between patients with abnormal myocardial ischemia and myocardial infarction（P〈0.001）. Conclusions The prevalence of coronary artery disease increases significantly in CKD patients, and adenosine 99 m Tc- MIBI myocardial perfusion imaging is an effective method for assessing ischemic myocardial injury in CKD patients. The increase of CTn I is closely related to the positive results of adenosine stress myocardial perfusion imaging,and CTn I is a predictor of cardiovascular events.