CAJ | 학술논문

【目的】评价腺苷负荷试验心肌灌注显像对冠心病的诊断价值及腺苷负荷试验的安全性。【方法】收集2011年2月至2013年2月在本院疑诊冠心病患者75例，均行腺苷负荷99m Tc-甲氧基异丁基异腈（MIBI）心肌灌注断层显像，腺苷按体重0．14 mg/（kg · min）通过输液泵静脉双通路给药，并对心肌灌注断层显像图作定性分析，所有患者1～3 d后行冠状动脉造影检查。【结果】75例患者中冠脉造影正常32例；1支以上狭窄≥50％者43例，其中单支病变14例，双支病变16例，三支病变13例；共检出病变血管85支，累及左前降支（L AD ）38支，左回旋支（LCX）28支，右冠状动脉（RCA）21支，左主干（LM）2支。腺苷负荷心肌灌注显像诊断冠心病的灵敏度为88．3％（38/43），特异性为87．5％（28/32），准确性为88．0％（66/75），阳性预测值为90．5％（38/42），阴性预测值为84．8％（28/33）。对病变冠脉诊断灵敏度为75．9％（63/83），特异性93．7％（133/142），准确性87．1％（196/225），阳性预测值为94．0％（63/67），阴性预测值为84．2％（133/158）。对单支、双支、3支血管病变诊断的灵敏度分别为50％（7/14）、62．5％（10/16）和92．3％（12/13）。对各病变血管检测灵敏度为：LAD 86．1％（31/36），LCX 55．6％（15/27），RC A 85％（17/20）。腺苷不良反应总发生率为80％（60/75）。【结论】腺苷负荷试验心肌灌注显像诊断冠心病敏感性及特异性均较高，并且不良反应轻微，是协助诊断冠心病安全有效的方法。
【목적】평개선감부하시험심기관주현상대관심병적진단개치급선감부하시험적안전성。【방법】수집2011년2월지2013년2월재본원의진관심병환자75례，균행선감부하99m Tc-갑양기이정기이정（MIBI）심기관주단층현상，선감안체중0．14 mg/（kg · min）통과수액빙정맥쌍통로급약，병대심기관주단층현상도작정성분석，소유환자1～3 d후행관상동맥조영검사。【결과】75례환자중관맥조영정상32례；1지이상협착≥50％자43례，기중단지병변14례，쌍지병변16례，삼지병변13례；공검출병변혈관85지，루급좌전강지（L AD ）38지，좌회선지（LCX）28지，우관상동맥（RCA）21지，좌주간（LM）2지。선감부하심기관주현상진단관심병적령민도위88．3％（38/43），특이성위87．5％（28/32），준학성위88．0％（66/75），양성예측치위90．5％（38/42），음성예측치위84．8％（28/33）。대병변관맥진단령민도위75．9％（63/83），특이성93．7％（133/142），준학성87．1％（196/225），양성예측치위94．0％（63/67），음성예측치위84．2％（133/158）。대단지、쌍지、3지혈관병변진단적령민도분별위50％（7/14）、62．5％（10/16）화92．3％（12/13）。대각병변혈관검측령민도위：LAD 86．1％（31/36），LCX 55．6％（15/27），RC A 85％（17/20）。선감불량반응총발생솔위80％（60/75）。【결론】선감부하시험심기관주현상진단관심병민감성급특이성균교고，병차불량반응경미，시협조진단관심병안전유효적방법。
Objective To evaluate the accuracy and safety of adenosine stress myocardial perfusion imaging in the diagnosis of coronary heart disease .[Methods]Totally 75 patients suspected as coronary heart disease in our hospital from Feb .2011 to Feb .2013 received adenosine 99m Tc-methoxy isobutyl isonitrile(MIBI) myocardial per-fusion imaging .According to the weight of 0 .14 mg/(kg · min) ,adenosine was administrated by infusion pump and venous double pathway .Myocardial perfusion imaging spectrum was used for quantitative analysis .Coronary angiography was performed in all patients after 1~3 days .[Results]Of 75 patients ,32 patients had normal coro-nary angiography ,and 43 patients had more than one stenosis vessel≥50% in which 14 cases were single vascular lesion ,and 16 cases were double vascular lesion ,and 13 cases were three vascular lesion .There were 85 diseased vessels .Involvement was found in 38 left anterior descending arteries(LAD) ,28 left circumflex arteries(LCX) ,21 right coronary arteries(RCA) and 2 left main(LM) .The sensitivity ,specificity ,accuracy ,positive predictive val-ue and negative predictive value of adenosine stress myocardial perfusion imaging in the diagnosis of coronary heart disease were 88 .3% (38/43) ,87 .5% (28/32) ,88 .0% (66/75) ,90 .5% (38/42) and 84 .8% (28/33) ,respective-ly .The sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive value of adenosine stress myocardial perfusion imaging in the diagnosis of coronary artery lesion were 75 .9% (63/83) ,93 .7% (133/142) , 87 .1% (196/225) ,94 .0% (63/67) and 84 .2% (133/142) ,respectively .The sensitivity of adenosine stress myo-cardial perfusion imaging in the diagnosis of single ,double and 3 vascular lesions were 50% (7/14) ,62 .5% (10/16) and 92 .3% (12/13) ,respectively .The sensitivity of adenosine stress myocardial perfusion imaging in the diag-nosis of LAD ,LCX and RCA were 86 .1% (31/36) ,55 .6% (15/27) and 85% (17/20) ,respectively .The total in-cidence rate of adverse reaction of adenosine was 80% (60/75) .[Conclusion]Adenosine stress myocardial perfusion imaging in the diagnosis of coronary heart disease has high sensitivity ,specificity and mild adverse reaction ,so it is a safe and effective method in the assistant diagnosis of coronary heart disease .