-
高血压是冠心病的主要危险因素之一, 估计全国患病人数达2亿[1]。核素心肌灌注显像(myocardial perfusion imaging, MPI)在冠心病的诊断、危险分层及疗效判断中有重要的价值[2], 它在高血压患者的研究中应用较多, 其应用价值已得到肯定。本研究用99Tcm-双(N-乙氧基, N-乙基-二硫代氨基甲酸酯)氮化锝(99Tcm-bis(N-ethoxy-N-ethyl-dithiocarbamato)nitridotechnetium, 99Tcm-N-NOET)对高血压患者进行MPI, 并观察其在临床应用中的价值。
-
高血压组60例患者中, 22例(36.7%)运动心电图呈阳性, 其中20例为ST-T改变、2例为心率失常, 其余38例运动心电图正常。16例(26.7%)运动中出现胸闷、胸痛, 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%)运动中胸闷, 无1例在运动中血压过度反应。高血压组较对照组在运动中心电图异常和出现血压过度反应的发生率明显增高(χ2=4.662, P < 0.05)。
-
高血压组: 19例(31.7%)出现心肌灌注异常, 共计25(25/540, 4.63%)个节段, 其中21个节段(84.0%)为可逆性缺损, 2个节段(8.0%)为部分可逆性缺损, 2个节段(8.0%)为固定性缺损。对照组: 出现心肌灌注异常1例(5.3%), 1个节段(0.01%) MPI提示可逆性缺损, 高血压组MPI阳性率明显高于对照组(31.75%vs.5.3%, P < 0.05)。
-
高血压组和对照组的运动和延迟的EDV、ESV、LVEF均无统计学差异(表 1)。显像中高血压组4例(6.7%)、正常对照组0例(0%)的运动LVEF < 50%;高血压组1例(1.7%)、正常对照组0例(0%), 延迟LVEF < 50%。高血压组△LVEF为负值的有28例(46.7%), 对照组有4例(21.1%), 高血压组心功能储备较对照组低(χ2=3.929, P < 0.05)。MPI阳性组和MPI阴性组之间运动和延迟EDV、ESV及LVEF均无统计学差异。MPI阳性组△LVEF为负值的有11例(57.9%), MPI阴性组有12例(29.3%), 两者比较有统计学差异(χ2=4.501, P < 0.05)。
运动M像 延迟显像 EDV(ml) ESV(mJ) LVEF(%) EDV(ml) ESV(ml) LVKK(%) 高血压组 79.75±29.10 28.82±15.73 65.78±1.27 81.42±3.47 30.62±2.05 64.20±9.70 对照组 79.63±21.65 27.37±10.71 66.42±1.55 82.89±4.96 31.42±3.06 63.16±7.5 t值 0.161 0.112 0.261 0.276 0.197 0.184 注:EDV为舒张未期容积,ESV为收缩末期容积,LVEF为左室射血分数。两组比较,各项参数均无统计学差异(P>0.05)。 表 1 高血压患者和正常对照者心肌灌注显像的心功能参数
-
19例行CAG的患者中, 11例冠脉造影异常, 8例正常; MPI结果: 9例心肌缺血, 10例正常, MPI和CAG均异常的有8例, MPI异常、CAG正常的有1例(图 1), MPI正常、CAG异常的有3例, MPI和CAG均异常的有7例。统计可知两种方法无差异(χ2=0.25, P > 0.05)。99Tcm-N-NOET运动+延迟门控MPI诊断高血压心肌缺血的灵敏度、特异度和准确率分别为72.7%、87.5%和78.9%。
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:
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。 -
关键词:
- 高血压 /
- 心肌灌注显像 /
- 99Tcm-双(N-乙氧基, N-乙基-二硫代氨基甲酸酯)氮化锝
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 group[exercise 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 group[exercise 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. -
表 1 高血压患者和正常对照者心肌灌注显像的心功能参数
运动M像 延迟显像 EDV(ml) ESV(mJ) LVEF(%) EDV(ml) ESV(ml) LVKK(%) 高血压组 79.75±29.10 28.82±15.73 65.78±1.27 81.42±3.47 30.62±2.05 64.20±9.70 对照组 79.63±21.65 27.37±10.71 66.42±1.55 82.89±4.96 31.42±3.06 63.16±7.5 t值 0.161 0.112 0.261 0.276 0.197 0.184 注:EDV为舒张未期容积,ESV为收缩末期容积,LVEF为左室射血分数。两组比较,各项参数均无统计学差异(P>0.05)。 -
[1] 董秋婷, 顼志敏. 原发性高血压临床防治的要点. 中国医刊, 2008, 43(09): 7-10. doi: 10.3969/j.issn.1008-1070.2008.09.003
[2] 范中杰, 陈黎波, 杜延荣, 等. 99Tcm氮欧乙替心肌核素显像的冠心病诊断分析. 中华医学杂志, 2006, 86(26): 1845-1849. doi: 10.3760/j:issn:0376-2491.2006.26.011
[3] 程燕, 李思进, 李险峰, 等. 99TcmN-NOET门控心肌灌注SPECT评价冠心病的价值. 国际放射医学核医学杂志, 2009, 33(5): 257-260. doi: 10.3760/cma.j.issn.1673-4114.2009.05.001
[4] 李思进, 胡光, 刘建中, 等. 99TcmN-NOEt门控心肌显像的临床应用. 中华核医学杂志, 2002, 22(3): 161-162.
[5] 刘海燕, 李思进, 武志芳, 等. 99Tcm-N-NOET运动MPI对可疑或确诊冠心病患者的预后评估价值. 中国医学影像技术, 2008, 24(5): 777-780. doi: 10.3321/j.issn:1003-3289.2008.05.038
[6] Elhendy A, Schinkel AF, Van Domburg RT, et al. Prediction of cardiac death in hypertensive patients with suspected or known coronary artery disease by stress technetlnm-99m tetrofosmin myocardial perfusion imaging. J Hypertens, 2003, 21(10): 1945-1951. doi: 10.1097/00004872-200310000-00023 [7] Elhendy A, van Domburg RT, Sozzi FB, et al. Impact of hypertension on the accuracy of exercise stress myocardial perfusion imaging for the diagnosis of coronary artery disease. Heart, 2001, 85(6): 655-661. doi: 10.1136/heart.85.6.655 [8] Houghton JL, Frank MJ, Carr AA, et al. Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am coll cardiol, 1990, 15(1): 43-51. doi: 10.1016/0735-1097(90)90173-M [9] 李小鹰, 李蕊, 于雯, 等. 老年高血压左心室肥厚患者冠状循环微血管病理改变特点. 中华心血管病杂志, 2001, 29(9): 527-530. doi: 10.3760/j:issn:0253-3758.2001.09.006
[10] 张欣, 张延军, 丁荣晶, 等. CAG正常的高血压患者心肌核素显像分析. 中国临床医学影像杂志, 2004, 15(4): 195-197.
[11] Matsumoto N, Sato Y, Suzuki Y, et al. Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome. Circ J, 2008, 72(12): 2035-2039. doi: 10.1253/circj.CJ-08-0488 [12] Yalçin H, Maza S, Yalçin F. Single photon emission computed tomography: an alternative imaging modality in left ventricular evaluation. Vasc Health Risk Manag, 2008, 4(5): 1069-1072.