CAJ | 학술논문

目的评价腺苷负荷试验心肌灌注显像在诊断老年人冠心病的准确性及临床应用的特点.方法 63例临床疑诊冠心病或已诊断但病情不稳定需介入治疗老年患者,住院后分别行腺苷负荷试验心肌灌注显像和冠状动脉(冠动)造影检查.腺苷负荷试验心肌灌注采用单光子发射断层显像图像采集系统,腺苷以140μg·kg-1·min-1静脉注射,用药时间6 min,注射过程中全程监测心电图、血压及患者的症状.于注射腺苷3 min末,静脉注射核素显像剂99cm Tc-MIBI 925 MBq,1.5 h后行心肌灌注断层显像,若显像异常,次日行静息心肌显像.冠脉造影按常规程序,在腺苷负荷试验心,肌灌注显像前后1周内进行.结果 63例中,53例冠脉造影阳性,10例阴性,而腺苷负荷试验心肌灌注显像51例阳性,7例阴性.腺苷负荷试验心肌灌注显像诊断老年人冠心病的总体敏感性为96.2%,特异性为70.0%,阳性预测值94.4%,阴性预测值77.8%,准确性为92.1%.53例冠脉造影显示,冠脉狭窄病变中,单支病变29例,二支14例,三支10例;累及左前降支(LAD)44支,左回旋支(LCX)18支,右冠脉(RCA)25支.腺苷负荷试验心肌灌注显像判断血管病变以LAD敏感性最高,达到95.5%;RCA次之,为84.0%;LCX最差,仅为55.6%;但特异性可达100%.监测过程中,32例(50.0%)患者发生胸闷、胸痛、头晕、头痛等不良反应,无严重事件发生.结论腺苷负荷心肌灌注显像诊断老年人冠心病的敏感性、特异性高,尤其对探查和定位严重的冠脉病变准确性更高;腺苷负荷试验过程中副作用小,且因检查无创,因此在老年人冠心病的临床诊断应用中具有重要的价值.
목적 평개선감부하시험심기관주현상재진단노년인관심병적준학성급림상응용적특점.방법 63례림상의진관심병혹이진단단병정불은정수개입치료노년환자,주원후분별행선감부하시험심기관주현상화관상동맥(관동)조영검사.선감부하시험심기관주채용단광자발사단층현상도상채집계통,선감이140μg·kg-1·min-1정맥주사,용약시간6 min,주사과정중전정감측심전도、혈압급환자적증상.우주사선감3 min말,정맥주사핵소현상제99cm Tc-MIBI 925 MBq,1.5 h후행심기관주단층현상,약현상이상,차일행정식심기현상.관맥조영안상규정서,재선감부하시험심,기관주현상전후1주내진행.결과 63례중,53례관맥조영양성,10례음성,이선감부하시험심기관주현상51례양성,7례음성.선감부하시험심기관주현상진단노년인관심병적총체민감성위96.2%,특이성위70.0%,양성예측치94.4%,음성예측치77.8%,준학성위92.1%.53례관맥조영현시,관맥협착병변중,단지병변29례,이지14례,삼지10례;루급좌전강지(LAD)44지,좌회선지(LCX)18지,우관맥(RCA)25지.선감부하시험심기관주현상판단혈관병변이LAD민감성최고,체도95.5%;RCA차지,위84.0%;LCX최차,부위55.6%;단특이성가체100%.감측과정중,32례(50.0%)환자발생흉민、흉통、두훈、두통등불량반응,무엄중사건발생.결론 선감부하심기관주현상진단노년인관심병적민감성、특이성고,우기대탐사화정위엄중적관맥병변준학성경고;선감부하시험과정중부작용소,차인검사무창,인차재노년인관심병적림상진단응용중구유중요적개치.
Objective To analyze the diagnostic accuracy and safety of adenosine stress 99mTc-MIBI myocardial perfusion single photon emission computed tomography(SPECT)for assessing coronary artery disease(CAD)in the elderly. Methods 63 elderly patients(≥65 years old)without myocardial infarction were enrolled in the research.They were admitted into hospital because of suspected CAD or suffering from acute coronary syndrome.Adenosine was infused intravenously at a rate of 140μg·kg-1·min-1 for 6 minutes.During the period.all patients were given electrocardiogram monitor and blood pressure detection,the uncomfortable symptoms were recorded.At the end of 3 minutes of adenosine infusion,925MBq of 99mTc-MIBI was injected intravenously.Then adenosine stress SPECT myocardial imaging acquisition was obtained.If the results were abnormal.the rest SPECT myocardial imaging would be performed next day.All patients underwentcoronary angiography(CAG)within 1 week before or after SPECT. Results In the 53 CAD patients diagnosed by CAG,there were 51 cases with positive adenosine 99mTC-MIBI myocardial perfusion SPECT.In 10 cases with normal CAG there were 7 cases with negative adenosine myocardial imaging.The results showed the sensitivity,specificity and accuracy of adenosine stress SPECT in detection of CAD in comparison with CAG were 96.2%,70.0%,92.1%respectively.The results of CAG also showed that 74 coronary arteries had been affected(defined as≥50%coronary vessel lumen reduction).There were 44 cases with affection in left anterior descending(LAD),18 eases in left circumflex(LCX)and 25 cases in right coronary artery(RCA).Correspondingly,there were 42 patients with lowering myocardial perfusion in anterior wall territory,10 patients in lateral wall territory and 21 patients in inferior wall territory.The sensitivity of adenosine 99mTc-MIBI myocardial perfusion SPECT for diagnosing LAD lesion was 95.5%,which was higher than for the other 2 coronary arteries,but the specificity for detecting LCX lesion was 100%.The adverse effects during the adenosine stress test were found in 50%patients,no serious events occurred.Conclusions Adenosine stress 99mTc-MIBI myocardial perfusion SPECT is a good noninvasive method with high diagnostic accuracy and safety in detection of CAD in the elderly,especially.highly accurate for detection and localization of significant CA D.