摘要
目的探讨多巴酚丁胺负荷^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)门控心肌灌注显像(G-MPI)诊断经皮冠脉介入术(PCI)后冠状动脉支架内再狭窄(ISR)的价值。方法选取2019年6月至2020年12月在郑州大学第二附属医院就诊的PCI术后3个月以上、伴有典型心绞痛症状、临床怀疑冠状动脉ISR的73例患者,进行回顾性分析。所有患者均于1个月内行多巴酚丁胺负荷^(99)Tc^(m)-MIBI G-MPI和冠状动脉造影(CAG)检查,以CAG作为金标准评价多巴酚丁胺负荷^(99)Tc^(m)-MIBI G-MPI诊断PCI术后冠状动脉ISR的价值。结果73例患者中共计94支冠状动脉植入支架,其中22例患者的25枚(26.6%)支架经CAG检查出现了ISR。22例中单支冠状动脉局部病变10例(45.5%),单支弥漫病变及多支病变12例(54.5%)。多巴酚丁胺负荷^(99)Tc^(m)-MIBI G-MPI诊断94支冠状动脉PCI术后发生ISR的准确性、灵敏度、特异性、阳性预测值、阴性预测值分别为91.5%(86/94)、88.0%(22/25)、92.8%(64/69)、81.5%(22/27)和95.5%(64/67)。诊断单支局部病变组与单支弥漫病变及多支病变组PCI术后ISR的灵敏度、特异性、阳性预测值和阴性预测值差异无统计学意义(P>0.05)。诊断植入直径≥3.50、3.00、≤2.75 mm支架组PCI术后ISR的灵敏度、特异性、阳性预测值和阴性预测值差异无统计学意义(P>0.05)。诊断糖化血红蛋白≥6.5%组与<6.5%组PCI术后ISR的灵敏度、特异性、阳性预测值差异无统计学意义(P>0.05),但阴性预测值差异有统计学意义(P<0.05)。结论多巴酚丁胺负荷^(99)Tc^(m)-MIBI G-MPI在冠心病患者PCI术后发生ISR中具有重要的诊断价值,尤其对高血糖或血糖控制不佳的患者是否发生ISR有较高的阴性预测值,可作为CAG检查前的初筛,是一种经济、有效、无创的诊断方法。
Objective To explore the value of dobutamine-stressed^(99)Tc^(m)-MIBI gated myocardial perfusion imaging(G-MPI)in diagnosing coronary in-stent restenosis(ISR)after percutaneous coronary intervention(PCI).Methods Seventy-three patients from June 2019 to December 2020 who were treated in the Second Affiliated Hospital of Zhengzhou University for more than 3 months after PCI,accompanied by typical angina symptoms and clinically suspected coronary ISR were included in this perspective study.All the patients underwent^(99)Tc^(m)-MIBI G-MPI and coronary angiography(CAG)within one month.CAG was used as the gold standard to evaluate the value of dobutamine-stressed^(99)Tc^(m)-MIBI G-MPI in diagnosing coronary ISR after PCI.Results Twenty-two patients with 25 coronary arteries(26.6%)showed ISR after CAG examination among 73 patients with 94 stented coronary arteries.Among the 22 patients,10 cases(45.5%)had local lesion in single coronary artery,and 12 cases(54.5%)had single branch diffuse lesion and multiple lesion in multiple branches.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of dobutamine-stressed^(99)Tc^(m)-MIBI G-MPI in diagnosing the occurrence of ISR in 94 coronary arteries after PCI were 91.5%(86/94),88.0%(22/25),92.8%(64/69),81.5%(22/27)and 95.5%(64/67),respectively.There were no statistical differences in the sensitivity,specificity,positive predictive value and negative predictive value of ISR after PCI between single-branch local lesion group and single-branch diffuse lesion and multi-branch lesion group(P>0.05).There were no statistical differences in the sensitivity,specificity,positive predictive value and negative predictive value of ISR after PCI among stent group implanted with diameter≥3.50 mm,stent group implanted with diameter equal to 3.00 mm,stent group implanted with diameter≤2.75 mm(P>0.05).There were no statistical differences in the sensitivity,specificity,positive predictive value of ISR after PCI between glycosylated hemoglobin≥6.5%group and glycosylated hemoglobin<6.5%group(P>0.05),but there was a statistical difference in the negative predictive value(P<0.05).Conclusion Dobutamine-stressed^(99)Tc^(m)-MIBI G-MPI has an important diagnostic value in evaluating ISR in patients with coronary heart disease after PCI.In particular,it has a high negative predictive value for ISR in patients with hyperglycemia or poor blood glucose control.Dobutamine-stressed^(99)Tc^(m)-MIBI G-MPI can be used as a preliminary screening before CAG examination,and it is an economical,effective and non-invasive diagnostic method.
作者
杨洋
杨萍
施梦丽
吕春歌
孙永敏
李晶
曹秋影
胡云龙
白雪
张亚平
YANG Yang;YANG Ping;SHI Mengli;Lü Chunge;SUN Yongmin;LI Jing;CAO Qiuying;HU Yunlong;BAI Xue;ZHANG Yaping(Department of Nuclear Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2021年第28期5208-5212,共5页
Henan Medical Research
基金
河南省科技攻关计划(182102311228)。
