CAJ | 학술논문

目的观察根据心电图等临床疑诊为成人病毒性心肌炎心肌缺血型患者的双嘧达莫负荷心肌~(201)Tl SPECT显像的表现.方法选取根据排除法临床疑诊为病毒性心肌炎后遗症——心肌缺血型患者79例,年龄19-55岁.按体质量0.56 mg/ks给予双嘧达莫,于4 min内静脉注射,2 min后注射~(201)Tl,注完后10及240 rain分别进行双嘧达莫负荷心肌~(201)Tl SPECT显像,原始图像经三维重建后由2位以上有经验的核医学科医师进行分析.不同性别组间显像结果比较行χ~2检验,经SAS 8.1软件处理.结果在有ST-T改变的79例患者中,所有患者双嘧达莫负荷~(201)Tl图像(10 min)均显示左心室心肌放射性分布正常,延迟(240 min)显像时有34例(43.04%)患者(包括正常共272个节段)出现部分心肌节段反向放射性分布稀疏或缺损,即"反向再分布",共累及36个节段:前壁9个(25.00%)、下壁11个(30.56%)、前间壁8个(22.22%)、前侧壁4个(11.11%)、心尖部4个(11.11%);其中单个节段受累32例(94.12%),2个节段受累2例(5.88%).79例中其余45例(56.96%)患者延迟显像则为放射性分布正常.有70.83%(17/24)的男性和30.91%(17/55)的女性患者延迟显像出现"反向再分布",不同性别间差异有统计学意义(χ~2=10.86,P<0.01).结论双嘧达莫负荷心肌~(201)Tl SPECT显像对指导缺血型心肌炎诊治有益,另外对有ST-T改变的女性患者诊断需慎重考虑.
목적 관찰근거심전도등림상의진위성인병독성심기염심기결혈형환자적쌍밀체막부하심기~(201)Tl SPECT현상적표현.방법 선취근거배제법림상의진위병독성심기염후유증——심기결혈형환자79례,년령19-55세.안체질량0.56 mg/ks급여쌍밀체막,우4 min내정맥주사,2 min후주사~(201)Tl,주완후10급240 rain분별진행쌍밀체막부하심기~(201)Tl SPECT현상,원시도상경삼유중건후유2위이상유경험적핵의학과의사진행분석.불동성별조간현상결과 비교행χ~2검험,경SAS 8.1연건처리.결과 재유ST-T개변적79례환자중,소유환자쌍밀체막부하~(201)Tl도상(10 min)균현시좌심실심기방사성분포정상,연지(240 min)현상시유34례(43.04%)환자(포괄정상공272개절단)출현부분심기절단반향방사성분포희소혹결손,즉"반향재분포",공루급36개절단:전벽9개(25.00%)、하벽11개(30.56%)、전간벽8개(22.22%)、전측벽4개(11.11%)、심첨부4개(11.11%);기중단개절단수루32례(94.12%),2개절단수루2례(5.88%).79례중기여45례(56.96%)환자연지현상칙위방사성분포정상.유70.83%(17/24)적남성화30.91%(17/55)적녀성환자연지현상출현"반향재분포",불동성별간차이유통계학의의(χ~2=10.86,P<0.01).결론 쌍밀체막부하심기~(201)Tl SPECT현상대지도결혈형심기염진치유익,령외대유ST-T개변적녀성환자진단수신중고필.
Objective The aim of this study was to explore the characteristics of dipyridamole ~(201)Tl SPECT myocardial perfusion imaging in patients clinically suspected of ischemic adult viral myocarditis(IAVM) based on electrocardiogram(ECG)changes.Methods Seventy-nine patients.age range 19-55,were studied in their post.IAVM sequelae period.All patients underwent pharmacologically stressed ~(201)Tl SPECT myocardial perfusion imaging after infusing 0.56 mg dipyridamole/kg intravenous iu 4 min.The early and de-layed SPECT images were acquired respectively at 10 min and 240 min after ~(201)Tl injection.Three-dimen-sional reconstructions of the original images were analyzed and reported by two or more experienced nuclear medicine physicians.The results of imaging between male and female genders were compared using χ~2-test with SAS 8.1 software.Results There were no abnormal myocardial perfusion findings in the early stress images in all patients.In the delayed study,however,43.04%(34/79) of patients had abnormal results with reversed perfusion defects in 36 segments,including 9 segments(25.00%)in the anterior wall.11 segments(30.56%)in the inferior wall,8 segments(22.22%)in the antero-septal wall,4 segments (11.11%)in the antero-lateral wall,and 4 segments(11.11%)in the apex.The perfusion defect of single segment was found in 32 patients.Reversed defects were identified in 70.83%(17/24)of male and 30.91%(17/55)of female.There was a significant difference in proportion of abnormal findings between male and female genders(χ~2=10.86.P<0.01).Conclusions Dipyridamole ~(201)Tl SPECT mvocardial perfusion imaging may have a value for diagnosis and treatment of the ischemic adult viral myocarditis.The ECG ST-T changes found in female may have higher false positive results and cautions should be taken.