99Tcm-N-NOET负荷和延迟门控心肌灌注显像对高血压患者的临床价值

The clinical value of 99Tcm-N-NOET exercise and delayed myocardial perfusion imaging in patients with hypertension

    摘要
  • 摘要:
    目的 探讨99Tcm-双（N-乙氧基, N-乙基-二硫代氨基甲酸酯)氮化锝（99Tcm-N-NOET）负荷和延迟心肌灌注显像(MPI)对高血压患者的临床应用价值。
    方法 对60例高血压患者和19例正常对照者进行99Tcm-N-NOET负荷+延迟MPI，并对MPI、运动心电图、心功能参数舒张末期容积（EDV）、收缩末期容积（ESV）、左室射血分数（LVEF）、△LVEF(LVEF运动-LVEF延迟)及冠状动脉造影（CAG）结果进行相关分析。
    结果 ① 高血压组60例患者中，22例(36.7%)运动中心电图阳性，16例(26.7%)运动中出现胸闷，13例(21.7%)运动中出现血压过度反应；对照组19例正常者中，2例(10.5%)运动心电图阳性，1例(5.3%)运动中出现胸闷，无运动中血压过度反应者。②高血压组MPI阳性率明显高于对照组(31.75%vs.5.30%, P< 0.05)。③高血压组运动和延迟的心功能参数运动EDV=（79.75±29.10）ml, ESV=（28.82±15.73）ml, LVEF=（65.78±1.27）%; 延迟EDV=（81.42±3.47）ml, ESV=（30.62±2.05）ml, LVEF=(64.20±9.70)%与对照组运动EDV=(79.63±21.65)ml, ESV=(27.37± 10.71)ml, LVEF=(66.42±1.55)%; 延迟EDV=(82.89±4.96)ml, ESV=(31.42±3.06)ml, LVEF=(63.16± 7.54)%均无统计学差异(运动EDV: t=0.161, ESV: t=0.112, LVEF: t=0.261；延迟EDV: t=0.276, ESV: t=0.197, LVEF: t=0.184，P< 0.05)，高血压组△LVEF为负值者有28例(46.7%)，对照组有4例(21.1%)，χ2=3.929，P < 0.05。MPI阳性而△LVEF为负值者有11例(57.9%)，MPI阴性而△LVEF为负值者有12例（29.3%）, χ2=4.501，P < 0.05。④高血压患者中19例行CAG，结果：11例异常，8例正常；行MPI结果：9例缺血，10例正常。两者比较无统计学差异(χ2=0.25，P > 0.05)。99Tcm-NNOET MPI的灵敏度、特异度和准确率分别为72.7%、87.5%和78.9%。
    结论 ① 99Tcm-N-NOET负荷+延迟MPI可用于诊断高血压患者是否伴有心肌缺血。②高血压患者的心功能储备降低，MPI阳性的高血压患者心脏储备功能更低。

     

    Abstract:
    Objective To investigate clinical significance of the 99Tcm-bis(N-ethoxy-N-ethyl-dithiocarbamato)nitridotechnetium(99Tcm-N-NOET)exercise and delayed myocardial perfusion imaging(MPI)in hypertensive patients.
    Methods Sixty patients with hypertension and 19 normal subjects were carried out 99Tcm-N-NOET exercise and delayed MPI, and analyzed the results of MPI, exercise electrocardiography(ECG), cardiac function parameters end-diastolic volume(EDV), end-systolic volume(ESV), left ventricular ejection fraction(LVEF), △LVEF(LVEF exercis-LVEF delay)and coronary angiography(CAG).
    Results ① Sixty patients with hypertension, 22 cases(36.7%)of exercise ECG were abnormal, 16 cases(26.7%)were the chest tightness in exercise, 13 cases(21.7%)were blood pressure excessive reaction in exercise; control group, 2 cases(10.5%)of exercise ECG were abnormal, 1 case(5.3%, 1/19)was chest tightness in exercise, no per-son was blood pressure response in excessive.②The positive rate of myocardial perfusion in hyper-tensive group was significantly higher than the control group(31.75%vs.5.30%, P < 0.05).③Cardial function parameters in hypertension groupexercise EDV=(79.75±29.10)ml, ESV=(28.82±15.73)ml, LVEF=(65.78± 1.27)%; delay EDV=(81.42±3.47)ml, ESV=(30.62±2.05)ml, LVEF=(64.20±9.70)%and control groupexercise EDV=(79.63±21.65)ml, ESV=(27.37±10.71)ml, LVEF=(66.42±1.55)%; delay EDV=(82.89±4.96)ml, ESV=(31.42±3.06)ml, LVEF=(63.16±7.54)%were no statistical difference(exercise EDV: t=0.161, ESV: t= 0.112, LVEF: t=0.261; delay EDV: t=0.276, ESV: t=0.197, LVEF: t=0.184, P > 0.05), △LVEF < 0%, 28 cases (46.7%)in hypertension group, 4 cases(21.1%)in control group, χ2=3.929, P < 0.05; 11 cases(57.9%)in MPI positive group, 12 cases(29.3%)in MPI negative group, χ2=4.501, P < 0.05.④Nineteen patients with hypertension underwent CAG, 11 cases were abnormal, 8 cases were normal.MPI results: 9 cases were ischemia, 10 cases were normal, and they were no statistical difference(χ2=0.25, P > 0.05).The sensitivity, specificity and accuracy of 99Tcm-N-NOET MPI were 72.7%, 87.5%and 78.9%.
    Conclusions ① 99Tcm-NNOET exercise and delayed MPI can diagnose whether hypertension patients with myocardial ischemia or not.②△LVEF of hypertensive patients reduced, △LVEF is lower in hypertensive patients of MPI-positive.

     

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