糖尿病与非糖尿病冠心病患者心肌葡萄糖代谢显像质量的影响因素

Influencing Factors of Myocardial Glucose Metabolism Imaging Quality in Diabetic and Non-Diabetic Patients with Coronary Heart Disease

目的分析影响糖尿病与非糖尿病冠心病患者18F-FDG PET心肌代谢显像成败及图像质量优劣的因素,为临床优化显像流程提供参考。资料与方法回顾分析2012年9月—2021年6月于苏州大学附属第三医院核医学科以“两日法”99Tcm-MIBI静息门控心肌灌注显像及18F-FDG PET心肌代谢显像评价存活心肌、拟行血运重建术的冠心病患者161例,其中冠心病合并糖尿病52例。根据视觉分析将PET心肌代谢显像图像分为优、中等和无法解释3个等级,采用多因素Logistic回归分析非糖尿病冠心病患者图像质量优劣以及冠心病合并糖尿病患者显像成败的影响因素。结果161例患者中,图像视觉分级为优和中等分别占65.2%(105/161)和19.3%(31/161),无法解释占15.5%(25/161)。52例冠心病合并糖尿病患者中,图像视觉分级为中等或无法解释分别占25.0%(13/52)和28.8%(15/52),109例冠心病非糖尿病患者中分别占16.5%(18/109)和9.2%(10/109),两组差异有统计学意义(χ2=14.370,P=0.001)。多因素Logistic回归分析显示,对非糖尿病冠心病患者,体重指数(OR=1.235,95%CI 1.056~1.444,P=0.008)和调节血糖时注射胰岛素剂量(OR=1.426,95%CI 1.047~1.941,P=0.024)是18F-FDG PET心肌代谢显像图像质量优劣的独立影响因素;对合并糖尿病冠心病患者,血脂异常(OR=12.156,95%CI 1.489~99.217,P=0.020)是18F-FDG PET心肌代谢显像失败的独立影响因素。结论糖尿病与非糖尿病冠心病患者18F-FDG PET心肌代谢显像成败、图像质量优劣的影响因素并不一致。在临床工作中需遵循个体化原则,优化显像流程。

Purpose To retrospectively analyze the factors affecting the success or failure of 18F-FDG PET myocardial metabolic imaging and the quality of images in diabetic and non-diabetic patients with coronary heart disease(CAD),and to provide a reference for clinical optimization of imaging process.Materials and Methods A total of 161 CAD patients who were evaluated for viable myocardium via"two-day method"to perform 99Tcm-MIBI rest-gated myocardial perfusion imaging and 18F-FDG PET myocardial metabolic imaging(MMI)and were all scheduled for revascularization in the Third Affiliated Hospital of Soochow University from September 2012 to June 2021 were retrospectively enrolled,and all data were further analyzed.Of all patients,there were 52 cases with diabetes.Based on visual analysis of PET MMI,all patients were divided into three levels,including good,moderate and unexplained levels.Logistic and multivariate regression were used to analyze the factors affecting image quality and success or failure of imaging.Results Of 161 patients,there were 65.2%(105/161)good grade images,19.3%(31/161)moderate grade images,and 15.5%(25/161)uninterpretable images,respectively.Of 52 CAD patients with diabetes,there were 25.0%(13/52)moderate images and 28.8%(15/52)uninterpretable images,respectively;of 109 CAD patients without diabetes,there were only 16.5%(18/109)moderate images and 9.2%(10/109)uninterpretable images,respectively(χ2=14.370,P=0.001).In CAD patients without diabetes,body mass index(OR=1.235,95%CI 1.056-1.444,P=0.008)and insulin dose injected during blood glucose regulation(OR=1.426,95%CI 1.047-1.941,P=0.024)were the two independent factors of 18F-FDG PET MMI images quality via multivariate logistic regression analysis,and in CAD patients with diabetes,dyslipidemia(OR=12.156,95%CI 1.489-99.217,P=0.020)was the independent factor leading to 18F-FDG PET MMI imaging failure.Conclusion The influencing factors to success or failure of 18F-FDG PET myocardial metabolic imaging and image quality are not fully consistent in diabetic and non-diabetic CAD patients.Therefore,we should follow the principle of individualization to optimize the imaging process in clinical practice.