摘要
目的采用MIBI+18F-FDG心肌灌注-代谢显像(DISA)评价冠心病心肌梗死患者存活心肌有或无收缩潜能,及其对临床决策的影响。方法选择临床确诊并行冠状动脉造影(CAG)的心肌梗死患者72例行DISA显像。根据DISA结果将本组病例分为存活心肌≥4个节段(A组)和存活心肌<4个节段(B组)两组,以小剂量多巴酚丁胺负荷心脏超声(LD-DSE)观察负荷前后结果。结果 72例心肌梗死患者共检出灌注缺损438个节段,其中A组250(6.6±3.4)个节段;B组188(4.6±1.8)个节段;t=7.32,P<0.001。共检出代谢缺损223个节段,其中A组158(5.0±2.6)个节段;B组65(2.7±1.2)个节段;t=6.83,P<0.001。Dob负荷状态下共检出室壁运动改善197个节段,其中A组71(2.1±1.4)个节段;B组126(3.6±2.3)个节段;t=4.57,P<0.001。DSE室壁运动指数(WMSI):A组同组静息与Dob负荷相比,t=6.33,P<0.001,B组同组静息与Dob负荷相比,t=10.11,P<0.001;无论是静息状态还是Dob负荷状态,A组和B组相比t=12.01、14.84,P<0.001。结论判断心肌梗死区存活心肌的多少及其恢复功能的潜能是临床治疗决策的重要依据,DISA-MIBI和LD-DSE联合检测可能是具有最大化决策指导价值的方法。
Objective To evaluate shrinkage potential of viable myocardium in patients with myocardial infarction and the impact on selection of clinical program by dual-isotope myocardial perfusion-metabolic imaging.Methods 72 cases myocardial infarction confirmed by clinical and coronary angiography were selected to DISA imaging.Based on the results of DISA,the patients whose viable myocardial segments were greater than 4 were divided into A group and the rest of the patients were divided into B group.The echocardiography result was detected respectively in resting and low-dose dobutamine stress.Results 438 segments of perfusion defects and 223 segments of metabolic defects were detected in 72 cases myocardial infarction.There were total 250 segments of perfusion defects and 158 segments of metabolic defects in A group and 188 segments of perfusion defects and 65 segments of metabolic defects in B group,and the average segmental myocardial perfusion defects were respectively（6.6±3.4）and（4.6±1.8）in A group and B group,while the average segmental myocardial metabolic defects were respectively（5.0±2.6）and（2.7±1.2）in A group and B group.The difference between them was significant（t=7.32,P0.001;t=6.83,P0.001）.The detection rate of myocardial viability was 30.2% （71/235） in A group and 69.6%（128/181） in B group.The difference between them was significant（χ2=35.18,P0.001）.The segments are 71 in A group and 126 in B group among 197segments of wall motion improving detected in dobutamine stress.The average segmental of wall motion improving respectively（2.1±1.4）and（3.6±2.3）in A group and B group.The difference between them was significant（t=4.57,P0.001）.In A and B group,the difference of WMSI between in resting and in dobutamine stress dobutamine stress was significant（t=6.33,P0.001;t=10.11,P0.001）.Both in the resting or in dobutamine stress,the difference of WMSI between A group and B group was significant（t=12.01,P0.001;t=14.84,P0.001）.Conclusion The amount of viable myocardium in myocardial infarction zone and the potential of functional recovery is an important basis for clinical decision-making,and DISA-MIBI and LD-DSE joint detection maybe one of the most valuable way to guide decision-making.
出处
《中国实用医药》
2010年第28期1-3,共3页
China Practical Medicine
