摘要
目的探讨18F-FDG／99Tcm-MIBI双核素心肌断层显像检测AMI患者存活心肌，评价该方法对心功能改善及预后判断的价值。方法98例[男87例，女11例，年龄（58±11）岁]确诊为AMI患者，均行18F-FDG／99Tcm-MIBI双核素心肌断层显像，采用半定量方法将心肌分成9个节段，并评分，放射性轻度减低=1分，明显减低=2分，缺损=3分。根据灌注和代谢显像情况，两者不匹配视为存活心肌，两者匹配为心肌无存活。治疗前后行超声心动图检查观察LVEF变化；所有患者进行随访，统计心脏事件发生率，比较再血管化治疗和药物治疗患者的心脏事件发生率差别。频数的比较采用x2检验。结果心肌存活组患者27例，接受冠状动脉再血管化和药物治疗者分别为27和10例；心肌无存活组61例，接受冠状动脉再血管化治疗和药物治疗者分别为35和26例。无论是心肌存活组还是心肌无存活组，再血管化治疗和药物治疗相比较，心功能明显改善（LVEF提高≥10％）的患者比例差异均无统计学意义（心肌存活组：矿=0．509，P〉0．05；心肌无存活组：x2=0．035，P〉0．05）。平均随访时间为（234-11）个月，心肌存活组接受药物治疗患者的心脏事件发生率明显高于接受再血管化治疗的患者（50．0％和14．8％,X2=4．91，P〈0．05）；在心肌无存活组，药物治疗患者的心脏事件发生率也同样明显高于再血管化治疗（30．7％和5．7％,x2=6．83，P〈0．05）。结论利用18F-FDG／99Tcm-MIBI双核素心肌断层显像检测AMI患者存活心肌，以判断心功能改善和预后，具有一定价值，同时也有局限性，还需要大规模前瞻性研究进一步证实。
Objective To investigate the value of is 18F-FDG/99Tcm-MIBI SPECT myocardial imaging for the detection of myocardial viability and prognosis in patients with AMI. Methods is 18F-FDG/99Tcm-MIBI SPECT myocardial imaging was performed in 98 consecutive patients [ man 87, women 11 ; average age （58 ± 11 ）y] with AMI. The myocardium was scored individually for nine segments： mildly decreased uptake = 1, significantly decreased uptake = 2, and no uptake = 3. Perfusion defect but preserved 18 F-FDG uptake was defined as perfusion-metabolism mismatch, indicating jeopardized but viable myocardium. Perfusion defect and decreased 18F-FDG uptake were defined as match, indicating myocardial necrosis. Echocardiogram was performed before and after treatment for evaluating the LVEF. All patients were followed after treatment. The rate of cardiac events was calculated and compared between patients with medication and revascularization. Paired t test, Chi-square test and log-rank test were used for statistical analysis. Results In the group with viable myocardium, 27 patients received revascularization and 10 received medication. In the group with infarcted myocardium, 26 patients received medication and 35 received revascularization. Patients underwent revascularization and with medication had no significant difference in improvement of LVEF between both groups （ viable myocardium group ： X2 = 0. 509, P 〉 0.05 ; infarcted myocardium group ： X2 =0.035, P 〉 0.05 ）. In viable myocardium group, cardiac event rate was significantly higher in patients with medication than in those who had undergone revascularization （50.0% vs 14.8% , X2 =4.91, P 〈0.05）. In the infarcted myocardium group, cardiac event rate was also significantly higher in patients with medication （30.7% vs5.7% ,X2 =6.83, P〈0. 05）. Conclusions 18F-FDG/99Tcm-MIBI SPECT myocardial imaging may well be of value but limited for the detection of myocardial viability and prediction of improvement in cardiac function as well as prognosis. However, more prospective data are needed for final evaluation.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2011年第1期34-38,共5页
Chinese Journal of Nuclear Medicine
基金
基金项目：“十一五”国家科技支撑计划课题（2007BA1051301）
