铊-201负荷心肌洗脱率评价心肌缺血与冠状动脉血流储备的对比研究Assessment of myocardial ischemia by myocardial Thallium-201 washout rate after dipyridamole infusion and comparison study with coronary flow reserve
魏盟,马士新,王齐冰,石洪成,姚之丰,陈绍亮
摘要(Abstract)：
目的 评价铊 2 0 1( 2 0 1 Tl)负荷心肌洗脱率在心肌缺血方面的应用价值 ,观察2 0 1 Tl负荷洗脱率与冠状动脉 (冠脉 )血流储备的相关性。方法 选择经冠脉造影证实的冠心病 (冠脉狭窄≥ 5 0 % )住院患者 2 5例 ,另外 2 3例经冠脉造影检查显示冠脉正常或狭窄 <5 0 %者作为对照组。行2 0 1 Tl双嘧达莫 (潘生丁 )负荷心肌显像检查 ,处理出靶心图后 ,计算局部室壁洗脱率。洗脱率 =(负荷态放射性计数 -延迟态放射性计数 ) 负荷态放射性计数× 10 0 %。在核素检查前后两周内行冠脉造影及冠脉内多普勒血流测定。结果 冠脉狭窄组室壁洗脱率显著低于对照组 [前壁 ( 2 6 89± 4 39) %vs ( 4 3 5 4± 9 0 8) % ;下壁 ( 16 81± 6 13) %vs ( 4 5 0 4± 9 6 6 ) % ;侧壁 ( 2 7 76± 9 0 1) %vs ( 4 3 87± 9 17) % ,P <0 0 0 1];冠脉狭窄组所测冠脉血流储备 (CFR =充血相平均峰值流速 静息相平均峰值流速 )值显著低于对照组CFR( 1 6 7± 0 6 3vs 2 85± 0 6 4 ,P <0 0 0 1) ;前壁洗脱率与前降支狭窄程度的相关性、侧壁洗脱率与回旋支狭窄程度的相关性差 (r =- 0 4 6 9,P =0 0 5 ;r =- 0 394 ,P =0 16 4 ) ;但下壁洗脱率与右冠脉狭窄程度之间的相关性较好 (r=- 0 6 6 1,P =0 0 0 5 ) ;室壁洗脱率与
关键词(KeyWords)： 洗脱率;放射性核素心室显像术;铊;冠状动脉血流储备
基金项目(Foundation):
作者(Author): 魏盟,马士新,王齐冰,石洪成,姚之丰,陈绍亮
参考文献(References)：
- 1InoueT ,FujitoT ,HoshiK ,etal.Relationshipofthallium201clearanceonexercisestressmyocardialscintigraphytocoronaryflowreserveinpatientswithcoronaryarterydisease.CoronArteryDis,1996,7:257263.
- 2TamotoS ,IshiharaT ,KojimaS ,etal.Assessmentoftheseverityofcoronaryarterydiseasebythallium201washoutrateafterdipyridamoleinfusionAcoronaryhemodynamicandmetabolicstudy.JpnCirJ ,1995,59:1121.
- 3魏盟,邵志丽,沈学东,等.多普勒导丝测定技术评价冠状动脉血流储备.中华内科杂志,2000,39:167.
- 4PohostGM ,BellerGA ,MckusideKA .Thallium201redistributionfollowingtransientmyocardialischemia.JNuclMed,1980,70:534540.
- 5OkadaRD ,LeppoJA ,BoucherCA ,etal.Myocardialkineticsofthallium201afterdipyridamoleinfusioninnormalcaninemyocardiumandinmyocardiumdistaltoastenosis.JClinInvest,1982,69:199209.
- 6NishiyamaH ,AdolphRJ,GabelM ,etal.Effectofcoronarybloodflowonthallium201uptakeandwashout.Circulation,1982,65:534542.
- 7FriedmanBJ ,BeihnR ,FriedmanJP .Theeffectofhypoxiaonthalliumkineticsinculturedthickmyocardialcells.JNuclMed,1987,28:14531460.
- 8TanakaJ,CounihanPJ ,GaneJN ,etal.Regionalthallium201washoutrateandmyocardialhypertrophyinhypertrophiccardiomyopathyanditsrelationtoexertionalchestpain.AmJCardiol,1993,72:211217.
- 9OpherkD ,MallG ,ZebeH ,etal.Reductionofcoronaryreserve:amechanismforanginapectorisinpatientswitharterialhypertensionandnormalcoronaryarteries.Circulation,1984,69:17.
- 10HasdaiD ,HolmesDRJr,HiganoST ,etal.Prevalenceofcoronarybloodflowreserveabnormalitiesamongpatientswithnonobstructivecoronaryarterydiseaseandchestpain.MayoClinProc,1998,73:11331140.
- 11BellerGA ,HolzgrefeHH ,WatsonDD .Effectsofdipyridamole inducedvasodilationonmyocardialuptakeandclearancekineticsofthallium201.Circulation,1983,68:13281338.
- 12GranatoJE ,WatsonDD ,BelardinelliL ,etal.Effectsofdipyridamoleandaminophyllineonhemodynamics,regionalmyocardialbloodflowandthallium201washoutinthesettingofacriticalcoronarystenosis.JAmCollCardiol,1990,16:17601770.