99mTc－MIBI门控心肌灌注显像在PCI术前及术后的应用价值

摘要

目的：探讨99m锝－甲氧基异丁基异腈（99mTc－MIBI）运动／静息门控心肌灌注显像（G－MPI）对于冠状动脉粥样硬化性心脏病（ CAD）患者行经皮冠状动脉介入治疗（ PCI）术前和术后的临床应用价值。方法选取2014年9月至2015年12月内蒙古医科大学附属医院接受PCI术的CAD患者30例，术前2周及术后3个月行99m Tc－MIBI 运动／静息G－MPI，对比手术前后心肌灌注异常节段、负荷／静息灌注总积分、左室射血分数（LVEF）、心室舒张末期容积（EDV）、心室收缩末期容积（ESV）及运动异常节段的变化。结果狭窄程度＞75％的44支血管对应320个节段，心肌可逆性缺损（ RD）患者的异常节段数术前和术后3个月差异有明显统计学意义（χ2＝231．867，P＜0．001）。心肌固定性缺损（FD）患者的异常节段数术前和术后差异无统计学意义（χ2＝3．398，P＞0．05）。 RD患者术前与术后3个月的负荷灌注总积分（SSS）、静息灌注总积分（SRS）的差异有统计学意义（t＝2．457，2．115，P＜0．05），FD患者术前和术后3个月SSS的差异有统计学意义（t＝2．042，P＜0．05），而SRS的差异无统计学意义（ t＝0．258，P＞0．05）。 PCI术后LVEF、EDV、ESV较术前增加，但差异无统计学意义（ t＝0．075，0．032，0．022；P＞0．05）。320个总节段中，运动异常节段数术前和术后差异无统计学意义（χ2＝3．570，P＞0．05）。结论99m Tc－MIBI运动／静息G－MPI对于CAD患者PCI术前治疗方案确定、病例选择、危险度分层及术后疗效评估均有一定的指导意义。%Objective To evaluate the clinical values of 99mTc-methoxyisobutylisonitrile (MIBI) gated myocardial perfusion imaging (MPI) in rest and stress states for coronary artery disease (CAD) patients before and after percutaneous coronary intervention (PCI). Methods Thirty CAD patients admitted in our affiliated hospital of Inner Mongolia Medical University from September 2014 to December 2015 were enrolled in the study .They all underwent PCI and 99m Tc-MIBI stress/rest gated MPI in 2 weeks before and 3 months after PCI .The abnormal segments and stress/rest scores of MPI before and after PCI or stent implantation , left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV) and segments of wall motion abnormalities before and after PCI were evaluated by ECTOOLBOX .Results There were 320 segments corresponding to 44 vessels with stenosis >75%. Significant differences were observed in the number of abnormal segments in the myocardial reversible defect ( RD) patients before and in 3 months after operation (χ2 =231.867, P<0.001), but not in the number among the myocardial fixed defect ( FD) patients before and after the treatment (χ2 =3.398, P>0.05).There were obvious differences in the summed stress score (SSS) and summed rest score (SRS) in the RD patients before and in 3 months after treatment (t=2.457, 2.115, P<0.05), so were in the SSS in the FD patients (t=2.042, P<0.05), but not in the SRS (t=0.258, P>0.05).The values of LVEF, EDV and ESV were all elevated after surgery, though without statistical differences (t=0.075, 0.032, 0.022, P>0.05).The number of segments of wall motion abnormalities had no significant difference before and after PCI (χ2 =3.570, P>0.05).Conclusion 99m Tc-MIBI stress/rest gated MPI is of guiding significance in therapeutic regimen , case selection , risk stratification before PCI and in the evaluation of the efficiency after PCI.