99Tcm-TF联合99Tcm-HL91心肌显像评估隐匿型冠心病患者预后价值

The Prognostic Value of 99Tcm-HL91 Hypoxia Imaging in Patients with Silent Coronary Heart Disease

目的探讨99Tc^m-TF(替曲膦tetrofosmin)门控心肌灌注显像(gated myocardial perfusion imaging,G-MPI)联合99Tc^m -HL91乏氧心肌显像评估隐匿型冠心病患者的预后价值。方法入选2015年1月至2016年7月间符合WHO诊断无症状心肌缺血(SMI)的患者共62例,根据99Tc^m-TF联合99Tc^m -HL91心肌显像结果显示心肌缺血累及范围又分为2个及以下阳性节段和2个以上阳性节段,随访1年以上,比较患者主要不良心血管事件(major adverse cardiovascular events,MACEs)发生情况。结果Cox单因素回归分析结果表明负荷心肌灌注总积分(SSS)升高、冠心病家族史、糖尿病及HL91显像结果是MACEs危险因素。Cox多因素回归分析结果表明,HL91显像的阳性结果是MACEs的独立危险因素(RR=15.349,95%CI:1.291~182.51,P=0.031),其余变量无预测作用。结论99Tc^m-TF G-MPI联合99Tc^m -HL91乏氧显像对于隐匿性冠心病患者预后判断以及临床选择治疗方法有一定的应用价值。

Objective To investigate the prognostic value of 99Tc^m-TF myocardial perfusion imaging combined with 99Tc^m-HL91 hypoxia imaging in patients with silent coronary heart disease.Methods A retrospective study was carried out on 62 patients who in accordance with the WHO diagnostic asymptomatic myocardial ischemia(SMI)and underwent 99Tc^m-TF SPECT stress MPI and 99Tc^m-HL91 hypoxia imaging from June,2013 to March,2016.According to the results they were divided into 2 and below positive segments and more than 2 positive segments.These patients were followed up for more than 1 year,we then compared the rate of MACEs(major adverse cardiovascular events,MACEs)between the two groups.Results Cox univariate regression analysis showed that increased summed stress score(SSS),family history of coronary heart disease,diabetes mellitus and HL91 imaging results were risk factors for MACEs.Cox multivariate regression analysis showed that the negative result of HL91 imaging was an independent risk factor for MACEs(RR=15.349,95%CI:1.291-182.51,P=0.031),and other variables had no predictive effect.Conclusion 99Tc^m-TF gated myocardial perfusion imaging combined with 99Tc^m -HL91 hypoxic imaging is useful in predicting the prognosis of patients with silent coronary heart disease,and can guide the clinic practice in selecting the therapy.