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目的:观察腺苷负荷核素心肌灌注显像(myocardial perfusion imaging,MPI)对于冠心病诊断的敏感性、特异性及其安全性。方法:对85例临床确诊或疑似冠心病患者行99m锝-甲氧基异丁基异腈(99mTc-MIBI)腺苷负荷和静息心肌灌注显像。腺苷注射过程中进行心电监测,观察并记录患者的症状、血压和心率;于注射腺苷1 h后进行MPI,次日常规行静息心肌灌注显像。其中67例患者在进行MPI后1个月内接受冠状动脉造影(coronary angiography,CAG)检查。以CAG结果为金标准,3条主要血管至少有1支血管管径狭窄≥50%为阳性标准进行分析。结果:①67例CAG检查患者中,获得阳性结果者52例,其中核素心肌灌注显像阳性46例;而CAG检查无明显狭窄的15例中,11例核素心肌灌注显像阴性。腺苷负荷MPI对于冠心病诊断的敏感性和特异性分别为88.5%和73.3%。②85例心肌灌注显像患者中,91.7%(78/85)出现各种不良反应,其中胸部不适83.3%(65/78),其次为潮热23.1%(18/78)、头昏20.5%(16/78)、心悸12.8%(10/78)、气短7.7%(6/78)、出汗7.7%(6/78),偶有恶心3.8%(3/78)、低血压3.8%(3/78)、呕吐1.3%(1/78)等。在停止注射腺苷5 min后,患者不良反应消失,心率、血压恢复至基础水平。结论:腺苷负荷MPI对于冠心病诊断的敏感性、特异性较高,不良反应较轻微,且终止试验后不良反应迅速消失,安全性较高。
Objective: To observe the sensitivity, specificity and safety of adenosine load myocardial perfusion imaging (MPI) in the diagnosis of coronary heart disease. Methods: Ninety-five 99m Tc-MIBI adenosine stress and resting myocardial perfusion imaging were performed on 85 clinically diagnosed or suspected CHD patients. During the process of adenosine injection, the ECG was monitored and the symptoms, blood pressure and heart rate of the patients were observed and recorded. MPI was performed 1 h after injection of adenosine, and resting myocardial perfusion imaging was carried out routinely. Sixty-seven of these patients underwent coronary angiography (CAG) within 1 month of MPI. To CAG results as the gold standard, the three major blood vessels at least one vascular diameter stenosis ≥ 50% of the positive criteria for analysis. RESULTS: Among the 67 CAG patients, 52 were positive, of which 46 were positive for radionuclide myocardial perfusion imaging. Of the 15 patients with no obvious stenosis by CAG, 11 were negative for myocardial perfusion imaging. The sensitivity and specificity of adenosine load MPI for the diagnosis of coronary heart disease were 88.5% and 73.3%, respectively. Among the 85 patients with myocardial perfusion imaging, 91.7% (78/85) showed various adverse reactions, including chest discomfort 83.3% (65/78), followed by hot flashes 23.1% (18/78) and dizziness 20.5% Heart rate was 7.7% (6/78), sweating 7.7% (6/78), occasional nausea 3.8% (3/78), and hypotension 3.8% (3/78) / 78), vomiting 1.3% (1/78) and so on. After stopping the injection of adenosine 5 min, the patient disappeared adverse reactions, heart rate, blood pressure returned to the basic level. Conclusion: The sensitivity and specificity of adenosine load MPI for the diagnosis of coronary heart disease are high, the adverse reactions are mild, and the adverse reactions disappear rapidly after the termination of the test, and the safety is high.