论文部分内容阅读
目的:探讨不合并阻塞性冠状动脉粥样硬化性心脏病(简称冠心病)的女性冠状动脉微血管性疾病(CMVD)患者PET/CT显像定量参数特征及其相关危险因素。方法:回顾性分析2017年9月至2019年8月间泰达国际心血管病医院的75例临床可疑CMVD女性患者(年龄25～77岁) n 13N-NHn 3·Hn 2O PET/CT动态定量显像资料。以PET/CT测定左心室整体冠状动脉血流储备(LV-CFR)值2.5为诊断界值分为CMVD组和非CMVD组，采用两独立样本n t检验或Mann-Whitney n U检验比较2组患者静息左心室整体心肌血流量(LV-MBF)和负荷LV-MBF的差异；收集患者个体特征参数，分析2组间的差异。相关性分析采用Pearson相关。n 结果:75例患者中，51例(68%)CMVD，24例(32%)非CMVD。CMVD组体质指数(BMI)高于非CMVD组[(26.93±3.52)和(23.83±3.42) kg/mn 2；n t＝3.63，n P＝0.001]，且LV-CFR与BMI呈负相关(n r＝-0.341，n P＝0.003)。超重组(BMI≥24 kg/mn 2)LV-CFR低于非超重组(BMI<24 kg/mn 2)(2.18±0.47和2.54±0.55; n t＝-2.89，n P＝0.005)。CMVD组中静息LV-MBF[0.74(0.65，0.84) ml·minn -1·gn -1]高于非CMVD组[0.66(0.58，0.75) ml·minn -1·gn -1；n U＝417.5，n P＝0.027]，负荷LV-MBF[(1.53±0.35) ml·minn -1·gn -1]、LV-CFR[2.07(1.71，2.34)]低于非CMVD组[(1.96±0.45) ml·minn -1·gn -1、2.86(2.61，2.95)；n t＝-4.54，n U＝0，均n P<0.001]。在高血压组内，CMVD亚组较非CMVD亚组的静息LV-MBF高[(0.77±0.16)和(0.65±0.13) ml·minn -1·gn -1；n t＝2.26, n P<0.05]，而负荷LV-MBF[(1.49±0.34)和(1.85±0.40) ml·minn -1·gn -1；n t＝-3.07，n P<0.05]和LV-CFR[1.99(1.64，2.23)和2.85(2.55，2.95)；n U＝0，n P<0.05]低。在非高血压组内，CMVD亚组较非CMVD亚组的负荷LV-MBF[1.53(1.36，1.97)和1.94(1.76，2.16) ml·minn -1·gn -1；n U＝43.5，n P<0.05]和LV-CFR[2.35(1.94，2.43)和2.87(2.65，3.09)；n U＝0，n P<0.05]低；高血压组中CMVD亚组LV-CFR低于非高血压组中CMVD亚组(n U＝164.0, n P＝0.028)。n 结论:BMI与CMVD的LV-CFR呈负相关，CMVD患者负荷LV-MBF减低、静息LV-MBF升高，导致LV-CFR降低。高血压是影响MBF和CFR的重要因素。“,”Objective:To diagnose female coronary microvascular diseases (CMVD) without obstructive coronary artery disease through coronary flow reserve (CFR) measured with PET/CT imaging, and further analyze its related risk factors of quantitative parameters and clinical characteristics.Methods:From September 2017 to August 2019, a total of 75 female patients (age: 25-77 years) with clinically suspected CMVD from TEDA International Cardiovascular Hospital were retrospectively analyzed. All patients had negative results of coronary angiography (CAG) or coronary CT angiography (CCTA) and underwent n 13N-NHn 3·Hn 2O PET/CT dynamic quantitative imaging. Left ventricle (LV) coronary flow reserve (LV-CFR) value of 2.5 for critical value was divided into CMVD group and non-CMVD group. Clinical characteristics and quantitative parameters including rest LV-myocardial blood flow (MBF) and stress LV-MBF were respectively analyzed and compared between groups. Independent-sample n t test, Mann-Whitney n U test and Pearson correlation analysis were used to analyze the data.n Results:Of 75 patients, 51 cases (68%) were diagnosed with CMVD and 24 cases (32%) with non-CMVD. Body mass index (BMI) of the CMVD group was higher than that of the non-CMVD group ((26.93±3.52) n vs (23.83±3.42) kg/mn 2, n t=3.63, n P=0.001), and LV-CFR was negatively correlated with BMI (n r=-0.341, n P=0.003). The LV-CFR of the overweight group (BMI≥24 kg/mn 2) was lower than that of non-overweight group (BMI<24 kg/mn 2) (2.18±0.47 n vs 2.54±0.55, n t=-2.89, n P=0.005). The rest LV-MBF in the CMVD group (0.74(0.65, 0.84) ml·minn -1·gn -1) was higher than that in the non-CMVD group (0.66(0.58, 0.75) ml·minn -1·gn -1; n U=417.5, n P=0.027), and the stress LV-MBF and LV-CFR was lower than that in the non-CMVD group ((1.53±0.35) n vs (1.96±0.45) ml·minn -1·gn -1, 2.07(1.71, 2.34) n vs 2.86(2.61, 2.95); n t=-4.54, n U=0, both n P<0.001). In the hypertensive group, the CMVD sub-group had higher rest LV-MBF than the non-CMVD sub-group ((0.77±0.16)n vs (0.65±0.13) ml·minn -1·gn -1; n t=2.26, n P<0.05), but lower stress LV-MBF ((1.49±0.34)n vs (1.85±0.40) ml·minn -1·gn -1; n t=-3.07, n P<0.05) and LV-CFR(1.99(1.64, 2.23)n vs 2.85(2.55, 2.95); n U=0, n P<0.05] than the non-CMVD sub-group. In the non-hypertensive group, stress LV-MBF and LV-CFR of the CMVD sub-group were lower than those of the non-CMVD sub-group (1.53(1.36, 1.97)n vs 1.94(1.76, 2.16) ml·minn -1·gn -1, 2.35(1.94, 2.43) n vs 2.87(2.65, 3.09); n U values: 43.5 and 0, both n P<0.05). LV-CFR of CMVD subgroup in hypertensive group was lower than that of CMVD subgroup in non-hypertensive group (n U=164.0, n P=0.028).n Conclusions:BMI is negatively correlated with LV-CFR in CMVD. The decrease of stress LV-MBF and the increase of rest LV-MBF in CMVD lead to the decrease of LV-CFR. Hypertension is one of the important influence factors for MBF and CFR.