CAG正常的高血压患者心肌核素显像分析

The analysis of myocardial radionucleid perfusion tomography in hypertension patientswith normal coronary angiography

目的:探讨冠脉造影(CAG)正常的高血压患者(HP)SPECT心肌灌注显像(MPT)特点及临床意义。方法:应用99Tcm-甲氧基异丁基异腈(MIBI)MPT定性与半定量记分法,比较20例CAG正常的HP患者及10例正常对照组运动负荷静息心肌显像特点。结果:①两组受检者MPT分析。HP组MPT阳性率为65%(1320),明显高于对照组10%(110);且多为可逆性缺损(3036),伴以少数部分可逆性缺损及反向分布(436,236)。HP组中,7例左室壁肥厚(LVH)患者均为MPT阳性,其节段灌注异常出现的机率要明显高于13例无LVH的患者(P<0.01)。HP组13例MPT阳性患者间比较,7例LVH患者节段灌注异常的发生率较6例无LVH患者无明显差异(P>0.05),但负荷显像其各节段缺血的严重程度明显高于6例无LVH患者(P<0.05)。②两组受检者左室射血分数(LVEF)值测定未见明显差异(P>0.05)。结论:①CAG正常的HP患者,无论是壁肥厚与否均存在心肌血流灌注异常的可能,并随着室壁肥厚的发生,其可能性及严重程度明显增加。②CAG正常的高血压患者静息状态下左室射血功能多无异常。

Objective: To evaluate the feature and clinical significance of SPECT myocardial perfusion tomography(MPT)in hypertension patients(HP) with normal coronary angiography(CAG). Methods: Qualitative and semi quantitative diagnosis, from gated stress and rest 99Tcm sestamibi(MIBI) MPT, were compared between 20 HP and 10 normotensive controls(NC). Results: ①The positive rate of MPT in HP was obviously higher than that of NC, which was 65% vs 10% respectively. Most foci of MPT were reversible defects(30/36), a few of them accompanied by partial reversible defects and reverse reversible defects(4/36, 2/36). The positive rate of abnormal segments in HP with left ventricular hypertrophy(LVH) was obviously higher than that of non LVH(P<0.01). In the 13 HP with positive MPT, the positive rate had no significant difference between LVH and non LVH(P>0.05), but the myocardial ischemia may be worse if hypertrophy was present(P<0.05). ②Analysis of heart functional data, there was no significant difference about LVEF between HP and NC(P>0.05). Conclusions: ①Abnormal MPT can exist in HP with normal CAG and not necessarily with LVH, but the degree of myocardial ischemia may be severe in patients with LVH. ②In rest state, the heart function of HP with normal CAG were normal.