心肌缺血%心肌梗塞%冠状动脉造影术%体层摄影术,发射型计算机,单光子%MIBI
心肌缺血%心肌梗塞%冠狀動脈造影術%體層攝影術,髮射型計算機,單光子%MIBI
심기결혈%심기경새%관상동맥조영술%체층섭영술,발사형계산궤,단광자%MIBI
Myocardial ischemia%Myocardial infraction%Coronary angiography%Tomography,emission-computed,single-photon%MIBI
目的 通过回顾性分析,评价99Tcm-MIBI心肌灌注显像的有效性及安全性.方法 选择来自6家医院共500例在1998年4月7日至2006年4月6日之间同时或者分别行99Tcm-MIBI MPI(包括静息显像和负荷显像)和CAG的患者.研究对象年龄33～88(60.1±11.1)岁,其中男335例,女165例.以CAG结果为“金标准”(1支血管狭窄≥50％为阳性),计算99Tcm-MIBI MPI的诊断效能.不同受累冠状动脉支数、狭窄程度及病变部位的99Tcm-MIBI MPI结果采用x2检验进行对比.统计所有患者在显像中的不良反应发生情况.结果 500例中运动负荷显像280例,药物负荷220例(腺苷负荷117例,ATP负荷71例,双嘧达莫负荷32例)；CAG阳性249例,阴性251例；累及LAD 205例,RCA 144例,LCX 130例；单支病变101例,双支病变66例,三支病变82例.99Tcm-MIBI MPI诊断心肌缺血及心肌梗死的灵敏度为65.1％(162/249),特异性为81.3％ (204/251),准确性为73.2％ (366/500),阳性预测值为77.5％(162/209),阴性预测值为70.1％(204/291).99Tcm-MIBI MPI对单支病变与双支病变的诊断灵敏度差异无统计学意义[52.5％ (53/101)与65.2％ (43/66),x2=2.624,P＞0.05],而对三支病变的诊断灵敏度明显高于单支+双支病变[80.5％ (66/82)与57.5％ (96/167),x2=12.801,P＜0.01].狭窄率为50％ ～59％、60％ ～ 69％、70％ ～ 79％、80％ ～89％、90％ ～99％的各组间灵敏度差异无统计学意义,分别为38.8％ (40/103)、39.6％(19/48)、43.4％ (53/122)、51.2％(41/80)、52.7％(48/91),x2=5.721,P＞0.05;狭窄率为100％时99Tcm-MIBI MPI的灵敏度[82.9％(29/35)]高于其他各组(x2=18.362,P＜0.01).99Tcm-MIBI MPI对LCX病变的诊断灵敏度低于LAD和RCA病变(x2=7.619,P＜0.01),特异性和准确性三者差异无统计学意义(x2=0.758和4.471,均P＞0.05).显像过程中,共发生轻度不良反应21例,患者均自行缓解.结论 99 Tcm-MIBIMPI无创、安全、有效,可用于心肌缺血或心肌梗死患者治疗方案的决策、预后判断和动态监测.
目的 通過迴顧性分析,評價99Tcm-MIBI心肌灌註顯像的有效性及安全性.方法 選擇來自6傢醫院共500例在1998年4月7日至2006年4月6日之間同時或者分彆行99Tcm-MIBI MPI(包括靜息顯像和負荷顯像)和CAG的患者.研究對象年齡33～88(60.1±11.1)歲,其中男335例,女165例.以CAG結果為“金標準”(1支血管狹窄≥50％為暘性),計算99Tcm-MIBI MPI的診斷效能.不同受纍冠狀動脈支數、狹窄程度及病變部位的99Tcm-MIBI MPI結果採用x2檢驗進行對比.統計所有患者在顯像中的不良反應髮生情況.結果 500例中運動負荷顯像280例,藥物負荷220例(腺苷負荷117例,ATP負荷71例,雙嘧達莫負荷32例)；CAG暘性249例,陰性251例；纍及LAD 205例,RCA 144例,LCX 130例；單支病變101例,雙支病變66例,三支病變82例.99Tcm-MIBI MPI診斷心肌缺血及心肌梗死的靈敏度為65.1％(162/249),特異性為81.3％ (204/251),準確性為73.2％ (366/500),暘性預測值為77.5％(162/209),陰性預測值為70.1％(204/291).99Tcm-MIBI MPI對單支病變與雙支病變的診斷靈敏度差異無統計學意義[52.5％ (53/101)與65.2％ (43/66),x2=2.624,P＞0.05],而對三支病變的診斷靈敏度明顯高于單支+雙支病變[80.5％ (66/82)與57.5％ (96/167),x2=12.801,P＜0.01].狹窄率為50％ ～59％、60％ ～ 69％、70％ ～ 79％、80％ ～89％、90％ ～99％的各組間靈敏度差異無統計學意義,分彆為38.8％ (40/103)、39.6％(19/48)、43.4％ (53/122)、51.2％(41/80)、52.7％(48/91),x2=5.721,P＞0.05;狹窄率為100％時99Tcm-MIBI MPI的靈敏度[82.9％(29/35)]高于其他各組(x2=18.362,P＜0.01).99Tcm-MIBI MPI對LCX病變的診斷靈敏度低于LAD和RCA病變(x2=7.619,P＜0.01),特異性和準確性三者差異無統計學意義(x2=0.758和4.471,均P＞0.05).顯像過程中,共髮生輕度不良反應21例,患者均自行緩解.結論 99 Tcm-MIBIMPI無創、安全、有效,可用于心肌缺血或心肌梗死患者治療方案的決策、預後判斷和動態鑑測.
목적 통과회고성분석,평개99Tcm-MIBI심기관주현상적유효성급안전성.방법 선택래자6가의원공500례재1998년4월7일지2006년4월6일지간동시혹자분별행99Tcm-MIBI MPI(포괄정식현상화부하현상)화CAG적환자.연구대상년령33～88(60.1±11.1)세,기중남335례,녀165례.이CAG결과위“금표준”(1지혈관협착≥50％위양성),계산99Tcm-MIBI MPI적진단효능.불동수루관상동맥지수、협착정도급병변부위적99Tcm-MIBI MPI결과채용x2검험진행대비.통계소유환자재현상중적불량반응발생정황.결과 500례중운동부하현상280례,약물부하220례(선감부하117례,ATP부하71례,쌍밀체막부하32례)；CAG양성249례,음성251례；루급LAD 205례,RCA 144례,LCX 130례；단지병변101례,쌍지병변66례,삼지병변82례.99Tcm-MIBI MPI진단심기결혈급심기경사적령민도위65.1％(162/249),특이성위81.3％ (204/251),준학성위73.2％ (366/500),양성예측치위77.5％(162/209),음성예측치위70.1％(204/291).99Tcm-MIBI MPI대단지병변여쌍지병변적진단령민도차이무통계학의의[52.5％ (53/101)여65.2％ (43/66),x2=2.624,P＞0.05],이대삼지병변적진단령민도명현고우단지+쌍지병변[80.5％ (66/82)여57.5％ (96/167),x2=12.801,P＜0.01].협착솔위50％ ～59％、60％ ～ 69％、70％ ～ 79％、80％ ～89％、90％ ～99％적각조간령민도차이무통계학의의,분별위38.8％ (40/103)、39.6％(19/48)、43.4％ (53/122)、51.2％(41/80)、52.7％(48/91),x2=5.721,P＞0.05;협착솔위100％시99Tcm-MIBI MPI적령민도[82.9％(29/35)]고우기타각조(x2=18.362,P＜0.01).99Tcm-MIBI MPI대LCX병변적진단령민도저우LAD화RCA병변(x2=7.619,P＜0.01),특이성화준학성삼자차이무통계학의의(x2=0.758화4.471,균P＞0.05).현상과정중,공발생경도불량반응21례,환자균자행완해.결론 99 Tcm-MIBIMPI무창、안전、유효,가용우심기결혈혹심기경사환자치료방안적결책、예후판단화동태감측.
Objective To evaluate the diagnostic accuracy and safety of 99Tcm-MIBI MPI by retrospectively analyzing data from this multicenter study.Methods Participating centers included six hospitals:Peking University First Hospital,Beijing Fuwai Hospital of Chinese Academy of Medical Science and Peking Union Medical College,Anzhen Hospital of Capital Medical University,Beijing Hospital of Health Ministry,Beijing Tongren Hospital of Capital Medical University and Peking University People's Hospital.According to the inclusion and exclusion criteria,500 subjects (335 male,165 female,mean age (60.1 ±11.1) years) who underwent MPI between April 1998 and April 2006 were enrolled.All subjects were investigated with stress/rest MPI and CAG within 1 month.Stress test was performed with bicycle ergometry or with intravenous dipyridamole,adenosine or ATP.Perfusion defects on MPI were allocated to corresponding coronary arteries.During the stress and imaging period,any discomfort or symptoms were recorded.Coronary stenosis with ≥ 50％ luminal narrowing was considered significant in CAG and taken as the gold standard.99Tcm-MIBI MPI results for the number of stenosed vessels,stenotic severity and coronary artery allocation were compared usingx2 test.Results There were 280 subjects that underwent exercise stress tests and the remaining 220 received pharmacological stress tests (117 adenosine,32 dipyridamole,71 ATP).Two hundred and forty-nine patients had significant coronary stenosis and 251 had normal CAG.Out of the 249 patients with positive CAG results,101 had one-vessel,66 had two-vessel and 82 had three-vessel disease.Significant stenosis of the LAD was present in 205 patients,144 had RCA stenosis and 130 had stenosis of the LCX.The sensitivity,specificity,accuracy,positive predictive and negative predictive values of MPI for detection of coronary artery disease were 65.1％ (162/249),81.3％ (204/251),73.2％ (366/500),77.5％ (162/209) and 70.1％ (204/291),respectively.There was no significant difference in the detection sensitivity of MPI between one-vessel disease and two-vessel disease (52.5％ (53/101) vs 65.2％ (43/66),x2 =2.624,P ＞ 0.05),while the sensitivity was significantly higher for three-vessel disease than that for one-vessel plus two-vessel disease (80.5％ (66/82) vs 57.5％ (96/167),x2 =12.801,P ＜ 0.01).The sensitivities among coronary artery stenosis subgroups of 50％-59％,60％-69％,70％-79％,80％-89％,90％-99％ were 38.8％ (40/103),39.6％ (19/48),43.4％ (53/122),51.2％ (41/80)and 52.7％ (48/91),respectively and not significantly different (x2 =5.721,P ＞ 0.05),while it was significantly higher in the subgroup with 100％ stenosis (82.9％ (29/35),x2 =18.362,P ＜ 0.01).The sensitivity for LCX lesions was lower than that for LAD and RCA (x2 =7.619,P ＜ 0.01),whereas the specificity and accuracy had no significant difference (x2 =0.758,4.471,both P ＞ 0.05).Mild side-effects during the study were recorded in 21 patients and were relieved without medical treatment.Conclusion 99Tcm-MIBI MPI is accurate and safe for the detection of coronary artery disease.
