冠心病左心室功能受损对脑葡萄糖代谢功能影响的相关性研究

Brain glucose metabolism was decreased in patients with coronary artery disease and severe left ventricular dysfunction

目的:测定冠心病左心室功能严重受损患者脑葡萄糖代谢的水平,评价左心室射血分数与脑葡萄糖代谢水平的相关性。方法:入选冠心病患者58例,3d内分别完成^(99m)Tc-MIBI静息门控心肌灌注SPECT/CT(GSPECT)断层显像和^(18)F-FDG门控心肌葡萄糖代谢PET/CT显像(GPET)以及脑葡萄糖代谢PET/CT显像检查。GPET数据采用定量门控心脏断层软件QGS分析,获取左心室功能参数,舒张末期容积(EDV),收缩末期容积参数(ESV)和左心室射血分数(LVEF)。采用脑功能软件Scenium定量分析脑葡萄糖代谢。比较左心室功能严重受损(LVEF≤25%)与无左心室功能严重受损患者(LVEF>25%)的脑葡萄糖代谢的差异,分析左心功能参数与脑葡萄糖代谢定量参数之间的相关性。结果:LVEF≤25%的患者(n=17)不同脑功能区的葡萄糖代谢(SUV_(mean))明显低于EF>25%的患者(n=41)(P均<0.05)。心肌梗死面积≥10%的患者(n=31)不同脑功能区的葡萄糖代谢也明显减低于心肌梗死面积<10%的患者(n=27)。Pearson相关分析发现,患者心肌梗死范围(r=-0.344,P=0.008)、LVEF(r=0.311,P=0.017)和ESV(r=-0.269,P=0.041)与小脑葡萄糖代谢SUV_(mean)之间存在相关性,差异均有统计学意义。结论:左心室功能严重受损患者(EF≤25%)和有大范围心肌梗死(≥10%)患者,脑葡萄糖代谢水平明显减低。

Objective： To measure the brain glucose metabolism in patients with severe left ventricular（ LV） dysfunction and evaluate the correlation of LV function parameters and myocardial viability on the brain glucose metabolism. Methods： Fifty-eight consecutive patients with coronary heart disease（ CAD）,referred for viability assessment,who were studied with ^（99mTc-sestamibi）ECG-gated SPECT rest myocardial perfusion imaging and ECG-gated ^（18）F-FDG PET/CT myocardial metabolic imaging,and were recruited in our study. Patients with cerebral infarction,cerebral hemorrhage,dementia and other brain diseases were excluded. LV functional pa-rameters（ EDV,ESV,and LVEF） were analyzed by QGS software. Brain imaging was acquired after cardiac PET/CT study,and brain glucose metabolism of average SUV（ SUV_（mean）） and maximal SUV（ SUVmax） was analyzed by Siemens scenium software. Further,relationship between brain glucose metabolism and LV functional parameters,viability information was analyzed by Pearson correlation analysis test. Finally,patients were clarified into with severe LV dysfunction（ LVEF ≤25%,n = 17,group 1） and without severe LV dysfunction（ LVEF 25%,n = 41,group 2）. Results： Age（ 56 ± 12） vs.（ 58 ± 11） years,glucose level（ mmol/L） at baseline（ 7. 3 ± 2. 6） vs.（ 6. 8 ± 2. 5） and at injection（ 7. 1 ± 1. 1） vs.（ 6. 7 ± 1. 3） did not differ between patients with or without severe LV dysfunction（ all P〈0. 05）. In comparison with patients in group 2,brain glucose metabolism was significantly decreased in group1 in frontal lobe,temporal lobe,parietal lobe,central region,occipital lobe,cingulate cortex,basal ganglia region,and cerebellum（ all P〈0. 05）. Brain glucose metabolism in all these regions was also significant reduced in patients with more than 10% of LV myocardium scar compared with patients with less than 10% of LV myocardium scar（ P〈0. 01）. Brain glucose metabolism in cerebellum（ SUV_（mean）） was positively significantly correlated with LVEF（ r = 0. 285,P = 0. 03）,and negatively correlated with ESV（ r =-0. 269,P = 0. 041） and the extent of myocardial scar（ % LV）（ r =-0. 344,P =0. 008）. No correlation was found between brain glucose metabolism and blood glucose level,EDV and the extent of viable myocardium. Conclusion： The whole brain glucose metabolism was decreased in patients with severe LV dysfunction（ LVEF≤25%） and in patients with 10% of LV myocardium scar.