CAJ | 학술논문

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χ2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:χ2=0.509,P>0.05;心肌无存活组:χ2=0.035,P>0.05).平均随访时间为(23±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%χ2=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%,χ2=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.
목적 탐토18F-FDG/99Tcm-MIBI쌍핵소심기단층현상검측AMI환자존활심기,평개해방법 대심공능개선급예후판단적개치.방법 98례[남87례,녀11례,년령(58±11)세]학진위AMI환자,균행18F-FDG/99Tcm-MIBI쌍핵소심기단층현상,채용반정량방법 장심기분성9개절단,병평분,방사성경도감저=1분,명현감저=2분,결손=3분.근거관주화대사현상정황,량자불필배시위존활심기,량자필배위심기무존활.치료전후행초성심동도검사관찰LVEF변화;소유환자진행수방,통계심장사건발생솔,비교재혈관화치료화약물치료환자적심장사건발생솔차별.빈수적비교채용χ2검험.결과 심기존활조환자27례,접수관상동맥재혈관화화약물치료자분별위27화10례;심기무존활조61례,접수관상동맥재혈관화치료화약물치료자분별위35화26례.무론시심기존활조환시심기무존활조,재혈관화치료화약물치료상비교,심공능명현개선(LVEF제고≥10%)적환자비례차이균무통계학의의(심기존활조:χ2=0.509,P>0.05;심기무존활조:χ2=0.035,P>0.05).평균수방시간위(23±11)개월,심기존활조접수약물치료환자적심장사건발생솔명현고우접수재혈관화치료적환자(50.0%화14.8%χ2=4.91,P<0.05);재심기무존활조,약물치료환자적심장사건발생솔야동양명현고우재혈관화치료(30.7%화5.7%,χ2=6.83,P<0.05).결론 이용18F-FDG/99Tcm-MIBI쌍핵소심기단층현상검측AMI환자존활심기,이판단심공능개선화예후,구유일정개치,동시야유국한성,환수요대규모전첨성연구진일보증실.
Objective To investigate the value of 18F-FDG/99Tcm-MIBI SPECT myocardial imaging for the detection of myocardial viability and prognosis in patients with AMI. Methods 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 18 F-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: χ2 = 0.509, P > 0. 05; infarcted myocardium group: χ2 =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%, χ2 =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% ,χ2 =6.83, P<0.05). Conclusions 18F-FDG/ -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.