摘要
目的:采用核素心肌灌注显像(MPI)发现早发冠心病(PCAD)心肌缺血患者,进而分析其临床特点,为早期识别高危患者提供依据。方法:以2015年1月至2016年1月,来我院经冠状动脉造影(CAG)确诊(冠状动脉管腔狭窄≥50%)的83例PCAD患者为研究对象,均行MPI检查,根据MPI异常与否分为阳性和阴性两组,对比MPI阳性组与阴性组冠状动脉造影的病变特点、超声心动(UCG)及一般资料等结果。结果:83例PCAD患者MPI阳性44例,MPI阳性组心肌缺血以左前降支供血区为主(54.5%);冠状动脉病变以左前降支受累最多(80.7%),以单支病变多发(48.2%);在冠状动脉单支、双支/左主干及3支病变中,MPI阳性组的敏感性分别为45.0%、53.6%和73.3%。MPI阳性组UCG左心室射血分数(EF)、左心室舒张末期内径(EDD)、左心室收缩末期内径(ESD)分别为(61.9±7.9)%、(48.84±5.52)和(32.36±5.92)mm;MPI阳性组超声心动左心室EDD、ESD均显著高于MPI阴性组(均为P<0.05);但左心室EF值显著低于MPI阴性组(P=0.040);MPI阳性组体质量、体质量指数(BMI)及尿酸(UA)均显著高于阴性组(P<0.05);多因素Logistic回归分析显示EDD和体质量为MPI阳性心肌缺血的显著指标(OR=1.721,11.129;P=0.028、0.027)。结论:MPI可作为早期发现PCAD患者心肌血供异常的有效手段。UCG的左心室结构和功能参数是MPI阳性患者的重要特征,以EDD及体质量更为显著,临床应重点观察。
Objective： This study was to diagnose myocardial ischemia in patients of premature coro- nary artery disease （PCAD） by myocardial perfusion imaging （MPI）, and analyze their clinical characters to provide the evidence of early diagnosis in high risk patients. Methods： Eighty-three patients of PCAD diag- nosed by coronary angiography （CAG） with coronary stenosis~〉50% in our hospital from January 2015 to Janu- ary 2016 were enrolled in this study. All patients underwent MPI. Then, they were divided into the positive group and the negative group according to the MPI resuhs. The characters of coronary artery lesion, the ultrasound cardiogram （UCG） and general data were analyzed. Results： 44 of 83 PCAD patients were positive in MPI results. The main myocardial isehemia area being supplied by the left anterior descending （54. 5% ） , and the left anterior descending branch involved most in the diseased vessels in patients of PCAD （80. 7% ）. Single vessel disease was more often than the other （48.2%）. Compared with CAG, the sensitivities in MPI positive group are 45.00%, 53.6% and 73.3% respectively in the single, two/left main and three-vessel coronary ar- tery stenosis. According to the UCG, the patients＇ left ventricular ejection fraction （EF）, end-diastolic dimen- sion （EDD） and end-systolic Dimension（ESD） was （61.9±7.9）%, （48. 84 ± 5.52）mm and （32. 36±5.92） mm, respectively. The values of EDD and ESD in the positive group were significant higher than that in the negative group （ P 〈 0. 05 ） , while the value of left ventricular EF in the positive group was significant lower than that in the negative group （P =0. 040）. Among those patients,the values of body mass, body mass index and uric acid in the positive group were significant higher than that in the negative group （P 〈 0. 05 ）. Multiple logistic correlation analysis showed that EDD and body mass were significant risk indicators in positive MPI with myocardial ischemia （ OR = 1. 721,11. 129 ; P = 0. 028, 0. 027 ）. Conclusion ： MPI is an effective method to early detect the abnormal myocardial blood supply ira patients with PCAD. The structural and functional parame- ters in left ventricle of UCG are the notable characters of ischemia in MPI. We should take more care about EDD and the body mass clinically which are the significant characters in positive MPI.
出处
《心肺血管病杂志》
2017年第3期222-225,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
早发冠心病
心肌灌注显像
冠状动脉造影
Premature coronary artery disease
Myocardial perfusion imaging
Coronary angiography
