SPECT/CT 心肌灌注显像在原发性微血管性心绞痛患者中的临床价值∗

摘要

目的：探讨SPECT/CT 心肌灌注显像在原发性微血管性心绞痛患者中的临床价值。方法回顾性分析36例原发性微血管性心绞痛患者(观察组)的SPECT/CT MPI结果，并将观察组患者的左心功能参数与42例正常对照组进行比较分析。结果(1)36例心肌缺血患者均为可逆性心肌缺血，共计70段，其中多壁段缺血的患者占83．3%(30/36)。(2)70个缺血壁段中，心尖部缺血占25．7%(18/70)，前壁缺血占31．4%(22/70)，下壁缺血占27．1%(19/70)，侧壁缺血占12．9%(9/70)，间壁缺血占2．9%(2/70)。缺血评分为1分、2分、3分者分别占85．7%(60/70)、11．4%(8/70)和2．9%(2/70)。(3)两组的左心功能参数：负荷LVEF、静息LVEF、负荷EDV、静息EDV、SSS和SDS之间均差异有统计学意义(均P<0．05)。结论原发性微血管性心绞痛患者SPECT/CT MPI特点是以多壁段受累为主的、可发生在任何壁段的可逆性心肌缺血，缺血程度较轻，且可能同时伴有左心功能的降低。%Objective To evaluate the clinical value of myocardial perfusion imaging( MPI) with SPECT/CT in patients with primary microvascular angina. Methods Imaging data of 36 patients with primary microvascular angina ( the experimental group) receiving MPI with SPECT/CT was analyzed retrospectively. Parameters of left ventricular function in the experimental group were compared with a normal control group of 42 cases. Results (1)All of the 36 patients with myocardial ischemia had reversible myocardial ischemia. A total of 70 ischemic segments were detected, wherein multi-segment ischemia accounted for 83. 3%( 30/36 ) . ( 2 ) Of the 70 ischemic segments, 18 ( 25. 7%) were at apex, 22 (31. 4%) in the anterior wall, 19(27. 1%) in the inferior wall, 9(12. 9%) in the septum, 2(2. 9%) in the lateral wall. Among the 70 segments, perfusion defects scores were 1, 2, and 3 in 85. 7%(60/70),11. 4%(8/70) and 2. 9%(2/70), respectively. (3)There was a significant difference between the normal control group and the experimental group in Left ventricular function parameters (LVEF, EDV, SSS and SDS; all P<0. 05). Conclusion The characteristics of MPI with SPECT/CT in primary microvascular angina was mainly reversible myocardial ischemia involving multi -wall segments. The reversible myocardial ischemia can occur in any segment of the myocardial wall, with mild severity. The patients with primary microvascular angina may have concommitant left ventricular function reduction.