99mTc-HL91心肌乏氧显像评价急性心肌梗死患者缺血/存活心肌的可行性

目的探讨急性心肌梗死（AMI）患者^99mTcHL91乏氧心肌显像的可行性及其临床应用价值。方法15例AMI患者行Tl-201和^99mTc-HL91双核素心肌显像，比较和描述两种核素心肌显像、缺血／存活心肌检测能力以及匹配方式。结果^99mTc-HL91可以提供较清晰的乏氧心肌图像并用于心肌节段分析；15例AMI患者行双核素显像，共255个节段，即刻Tl-201显像示异常节段109个，占43％；^99mTc-HL91显像示阳性节段160个，占63％。即刻Tl-201显像判断为异常的109个节段中，24hTl-201延迟显像示40个（部分）可逆性节段（缺血／存活心肌），占37％；^99mTc-HL91显像示73个阳性节段，占67％，其中40个（部分）可逆节段均呈乏氧阳性显像。^99mTc-HL91显像检测缺血／存活心肌能力显著高于TF201（P〈0．01）。结论^99mTc-HL91可以用于AMI患者缺血／存活心肌乏氧成像并用于心肌节段分析。乏氧显像可为研究冠心病提供新手段。     

99mTc-HL91乏氧显像在非小细胞肺癌化疗中的应用

目的 探讨晚期非小细胞肺癌(NSCLC)肿瘤病灶乏氧状态和化疗疗效.方法 对35例晚期NSCLC患者行99mTc-HL91显像,根据早期(1 h)和延迟(4h)结果进行定量和半定量分析,统计肿瘤/正常肺组织(T/N)值,判断是否存在差异.所有患者采用长春瑞滨联合顺铂(NP)方案化疗,对两组化疗近期疗效进行比较.结果 11例乏氧显像阳性者99mTc-HL91早期、延迟T/N值均明显高于24例乏氧显像阴性者(t=8.713,均P＜0.05); 99mTc-HL91阴性组化疗近期有效率62.5％(15/24)明显高于阳性组27.3％(3/11)(x2=10.23,P＜0.05);阴性显像组中腺癌化疗近期有效率84.6％(11/13例)高于鳞癌36.4％(4/11),组间比较有显著差异(Hc=3.261,P＜0.05).结论 利用99mTc-HL91合氧显像能清晰显示晚期NSCLC病灶的乏氧状态,而且乏氧是导致肺癌患者对化疗不敏感的因素之一.     

硝酸甘油介入99mTc-MIBI心肌断层显像对心肌梗塞患者存活心肌的评价

探讨硝酸甘油介入锝99甲氧基异丁异腈（99mTC－MIBI）心肌断层显像对心肌梗塞患者存活心肌的检出率。21例陈旧性心肌梗塞（OMI）静脉注入99mTc－MIBI30mci,90分钟后静态心肌显像,隔日硝酸甘油1mg舌下含化2分钟再注射99mTc－MIBI行药物介入心肌显像。21例患者共分析189个节段,以计分法对各节段核素分布情况进行半定量评价。静息心肌断层显像共有68个梗塞节段,药物介入后,硝酸甘油显像有32个节段灌注改善,占47．1％。提示硝酸甘油介入可明显提高99mTc－MIBI心肌断层显像对存活心肌的检出率。     

微量多巴酚丁胺介入心肌断层显像评价心肌梗死病人存活心肌

目的 探讨微量多巴酚丁胺介入99mTc－甲氧基异丁基异丁基异腈（MIBI）心肌断层显像评价存活心肌的价值。方法 对25例心肌梗死病人先行静肪心肌断层显像，24小时后行微量多巴酚丁胺介入显像并行对比分析。结果 25例病人静息心肌断层显像有78个节段放射性分布异常，多巴酚丁胺介入后有50个（64．1％）节段灌注改善。结论 微量多巴酚丁胺介入心肌断层显像是临床评价心肌存活安全、可靠且无创的方法。     

11例早期肺癌^99Tc^m—MIBI肺显像诊断价值探讨

目的 探讨应用^99Tc^m-甲氧异丁基异腈(MIBI)肺显像诊断早期肺癌的价值。方法 收集经手术与病理证实的11例I期肺癌病例，进行^99Tc^m-MIBI肺显像并与X线片、CT检查准确率回顾对照分析。结果 11例患者平面显像有8例阳性考虑恶性，另3例平面显像阴性；其中阴性2例补充断层显像发现异常浓聚灶，考虑为恶性。核素显像符合率90．91％。CT扫描结果提示肺癌4例，肺结核2例，5例无法定性；CT定性诊断准确率44％。结论 应用^99Tc^m-MIBI肺显像是肺结节定性诊断有效而敏感的方法。     

急性心肌梗塞病人住院期的顿抑心肌预测

根据Ｃｈｒｉｓｔｉａｎ等提出的急性心肌梗塞时左室射血分数与梗塞面积关系的回归方程，对５４例住院接受溶栓治疗的急性心肌梗塞病人的核素心肌灌注显像和心室造影结果进行分析，发现其中１８例（３３３％）存在有左室射血分数和梗塞面积不匹配现象。进一步观察发现，这１８例病人中１４例（７７８％）梗塞６周后左室射血分数明显改善。提示急性心肌梗塞病人住院期左室射血分数与梗塞面积不匹配现象，可以预测顿抑心肌的存在，阳性预测值达７７８％。     

药物与运动核素心肌灌注显像不良反应的临床分析

目的 比较腺苷负荷试验与运动负荷试验在99mTC-甲氧异丁基异腈(MIBI)核素心肌灌注显像中的不良反应.方法 2460例临床确诊或可疑冠心病患者做负荷心肌灌注显像,其中504例(A组)药物负荷采用静脉注射腺苷90 mg/30 ml,剂量140 μg·kg-1·min-1,持续泵入至6 min,于注射腺苷3 min末,静脉注射核素显像剂99mTC-MIBI 20 mci (740MBq),1.5h后行心肌灌注断层显像；1956例(B组)采用常规运动试验.结果 A组发生严重不良反应(心绞痛、窦性心动过缓)而终止试验的发生率为3.8％(19/504),轻度不良反应可完成试验的患者为73.0％(368/504),仅有轻微不良反应或无任何不适而顺利完成试验者为23.2％(117/504).均低于B组的4.3％(84/1956)、65.8％(1287/1956)和29.9％(585/1956).结论 与运动负荷相比,腺苷心肌药物负荷试验不良反应发生率较低,可安全用于不能进行运动负荷的患者.     

^99mTc标记的抗心肌肌钙蛋白Ⅰ单克隆抗体在心肌损伤大鼠体内的分布

目的研究^99mTc标记的抗心肌肌钙蛋白Ⅰ单克隆抗体（AcTnIMA）在实验性心肌损伤大鼠体内的分布，探讨^99mTc-AcTnIMA是否可以作为心脏放射免疫显像剂。方法第一批大鼠实验组：20只急性心肌损伤大鼠注射^99mTc-AcTnIMA0．2mci，分别于注射后2、4、6、8h处死（每次5只），取血液、肝、脾、肾、正常肌肉、肺、心脏，计算每克组织计数占总注入计数的百分比（ID％／g）及心-肺ID％／g比（HLR）；药物对照组：20只急性心肌损伤大鼠注射^99mTc标记的非特异性免疫球蛋白（N-IgG）0．2mci，处死方法同实验组。取肺及心脏，计算ID％／g及HLR；空白对照组：20只正常大鼠注射^99mTc-AcTnIMA0．2mci，处理方法同药物对照组。第二批50只心肌损伤大鼠分别于发生心肌损伤后2、4、6、8、12、24h，3、5、10、15d分10次静脉注射^99mTc-AcTnIMA0．2mci（每次5只），注射后4h处死，计算出ID％／g及HLR。结果损伤心肌摄取^99mTc-AcTnIMA为特异性摄取，摄取的高峰时间为4h；损伤心肌摄取^99mTc-AcTnIMA与损伤发生时间无关。结论^99mTc-AcTnIMA有望作为心脏放射免疫显像剂诊断心肌损伤。     

99Tcm-HMPAO-WBC显像对女性可疑腹部感染性疾病的诊断应用

目的 评价炎症显像剂^99Tc^m-HMPAO-WBC对女性可疑腹部感染性疾病的诊断价值。方法 对ll例怀疑有腹部感染的女性惠者行^99Tc^m-HMPAO-WBC显像，显像时间为注入显像后120min、180min。结果 ll例患者7例阳性，4例阴性。对比手术、内镜检查以及6个月随访结果，假阳性1例，无假阴性。^99Tc^m-HMPAO-WBC显像对女性可疑腹部感染性疾病的敏感性、特异性和准确率分别为100％、80％和90．9％。结论^99Tc^m-HMPAO-WBC显像是一种敏感、准确的早期诊断和鉴别女性可疑腹部感染性疾病的方法。     

延迟的心肌灌注改善现象—PTCA后潘生丁核素心肌灌注随访研究

为研究成功的经皮冠状动脉腔内成形术（PTCA）后心肌灌注变化情况，对24例非心肌梗塞患者分别于PTCA前，PTCA后1个月及12个月内进行了潘生丁核素心肌灌注显像检查。共分析49个缺血节段，结果20例心肌灌注显像异常（40个节段）在1个月内完全恢复正常，4例在此时间内心肌灌注（9个节段）未能完全恢复正常，而在其后的随访中完全恢复正常（2例），呈现“延迟”的心肌灌注改善现象。表明PTCA后较短时间内异常的负荷心肌灌注显像并不总表示残余冠状动脉狭窄或早期再狭窄。     

Comparative study of vascular effects of four calcium antagonists using a multi-organ functional imaging technique with thallium-201

The vasoactive effects of calcium antagonist drugs were compared using a multi-organ functional imaging technique with thallium-201 (Tl-201). Four drugs were tested at two different doses: nifedipine (10 and 25 micrograms/kg), verapamil (100 and 250 micrograms/kg), diltiazem (100 and 250 micrograms/kg), and bepridil (2.5 and 10 mg/kg). Tl-201 was injected at three different times after drug administration to examine the time course of the effects of the drugs. The regions studied were heart, liver, kidneys, shoulder skeletal muscles, and lungs. The results showed marked changes in Tl-201 biodistribution in anesthetized dogs after administration of calcium antagonists. The major increases in count density were observed in heart and skeletal muscles, but the drug effects differed in intensity and duration. Nifedipine induced the largest variations in the doses used (136 and 153% in the heart 2 min after 10 and 25 micrograms/kg doses, respectively). Diltiazem and verapamil were most efficient at 250 micrograms/kg (134 and 115% at 2 min after injection, respectively). With bepridil the increases of cardiac and muscular uptakes of Tl-201 were transient and the 2.5 mg/kg dose induced a decrease of myocardial count density (84% at 5 min). The effects were less reproducible in the other organs studied.     

99mTc-HL91显像监测荷瘤鼠高压氧后乏氧状况

目的 99mTc-HL91乏氧显像评价肿瘤高压氧后的乏氧状况.方法 20只荷H22肝癌KM小鼠随机分为4组,每组5只;(1)对照组,只进行99mTc-HL91乏氧显像;(2)15 min组,出高压氧舱后15 min行99mTc-HL91乏氧显像;(3)30 min组,出高压氧舱后30 min行99mTc-HL91乏氧显像;(4)60 min组,出高压氧舱后60 min行99mc-HL91乏氧显像.在平面图像上,通过核医学感兴趣区(regionfinteresting,ROI)技术,计算肿瘤与对侧相应部位放射性比值(T/NT),图像采集结束后立即处死小鼠,完整剥离肿瘤,称重并计算放射性计数,计算肿瘤微分摄取率(DUR).结果 15 min组、30 min组DUR及T/NT与对照组比较,差异有统计学意义(P＜0.05),60 min组与对照组比较,差异无统计学意义(P＞0.05).结论 99mTc-HL91显像是一种有价值的评价肿瘤高压氧后乏氧状况的方法.     

C-反应蛋白和抗心磷脂抗体与不稳定型心绞痛的关系

目的 探讨C-反应蛋白（CRP）和抗心磷脂抗体（ACA）对不稳定型心绞痛（UA）的临床应用价值。方法对116例UA患者分别测定CRP、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）、ACA。结果CRP升高67例（57．8％），cTnI升高19例（16．4％），CK—MB升高21例（18．1％），ACA阳性45例（38．8％）。6个月中发生急性心肌梗死（AMI）15例，心源性猝死3例。其中CRP升高组和ACA阳性组AMI的发生率明显高于正常组（P＜0．01）。多因素Logistic回归分析ClIP升高、ACA阳性、cTnI升高、陈1日性心肌梗死和胸痛次数是预测近期AMI和心源性猝死的独立危险因素。结论CRP和ACA对UA患者的近期预后与早期治疗有重要的临床价值，可作为UA患者的常规检测指标。     

不同类型冠心病患者血浆D-二聚体、纤维蛋白原含量的变化

目的 :探讨D -二聚体、纤维蛋白原 (Fg)水平以评估不同类型冠心病患者凝血、纤溶活性的临床意义。方法 :采用定量酶联免疫吸附法和全自动血凝分析仪检测冠心病患者126例 ,其中急性心肌梗死 (AMI)42例 ,不稳定型心绞痛 (UA)36例 ,稳定型心绞痛 (SA)48例和30例正常对照组的D -二聚体及纤维蛋白原水平。结果 :D -二聚体和Fg的阳性发生率及含量,UA和AMI患者组明显高于SA组及对照组(P<0.01) ;SA组患者的D -二聚体和Fg与对照组比较差别无统计学意义 (P>0.05) ;UA组D -二聚体阴性组的Fg水平小于阳性组 (P<0.05) ,而AMI这两组Fg水平差别无统计学意义 (P>0.05)。结论 :冠心病患者D -二聚体及Fg 含量越高 ,越易发生AMI ,UA组D -二聚体、Fg增高者可有血栓形成。D -二聚体和Fg含量测定可作为冠心病患者发生新鲜血栓形成的指标     

联合检测血清Hcy和Lp (a)与UA对冠心病患者预后评估的价值探讨

目的 探讨血清同型半胱氨酸(Hcy)、脂蛋白a[Lp(a)]和尿酸(UA)联合检测对冠状动脉粥样硬化性心脏病(CHD)的病情及预后的评估价值.方法 选取CHD患者96例(疾病组)和体检健康者50例(正常组),采集清晨空腹静脉血,检测血清Hcy、Lp(a)和UA.观察组(疾病组)随访1年,91例病情缓解或无进展,5例发展为急性心肌梗死(AMI).采用受试者工作特征曲线分析血清Hcy、Lp(a)和UA单独及联合检测对CHD患者预后的诊断价值.结果 疾病组血清Hcy、Lp(a)和UA水平均高于正常组(均P＜ 0.05);随访发展为AMI患者入院时血清Hcy、Lp(a)和UA水平均高于病情缓解或无进展者(均P＜ 0.01).Hcy、Lp(a)和UA联合检测对CHD患者预后评估的AUC为0.855、敏感性为89.4％、特异性为80.2％、阳性预测值86.4％,均高于3项单独检测.结论 冠状动脉粥样硬化性心脏病患者血清Hcy、Lp (a)和UA水平均升高,其水平变化可反映冠状动脉粥样硬化性心脏病病情,三者联合检测可提高对患者预后的判断价值.     

不稳定型心绞痛与急性心肌梗死患者血清膜联蛋白A1表达的差异

目的探讨不稳定型心绞痛与急性心肌梗死患者血清膜联蛋白A1表达的差异及其意义。方法90例冠心病患者按临床诊断分为不稳定型心绞痛组（54例）及急性心肌梗死组（36例）,选择冠状动脉造影结果为阴性的成年人30例作为对照组。检测3组受试者血清膜联蛋白A1浓度。结果膜联蛋白A1表达情况：对照组为（3．24±O．16）μg/L,不稳定型心绞痛组为（0．684±0．15）μg/L,急性心肌梗死组为（0．35±0．18）μg/L。不稳定型心绞痛组与急性心肌梗死组患者血清膜联蛋白A1表达水平均高于对照组,差异有统计学意义（均P＜0．05）,急性心肌梗死组患者血清膜联蛋白A1表达水平高于不稳定型心绞痛组,差异有统计学意义（P＜0．05）。结论冠心病患者血清膜联蛋白A1表达抑制,其表达水平同冠心病病情程度相关,检测血清膜联蛋白A1有助于评估病情及预后。     

Predictors of high-cost managed care patients with acute coronary syndrome

OBJECTIVE: To develop predictive models of high-cost acute coronary syndrome (ACS) patients using demographic, disease, and treatment characteristics. STUDY DESIGN: This was a retrospective, administrative claims analysis utilizing pharmacy, medical, and eligibility data from a large US managed care organization. METHODS: ACS was defined by ICD-9 codes for unstable angina (UA) or acute myocardial infarction (AMI). New onset patients (without ACS claims) in the prior six months were identified for the time period 07/01/99-06/30/01, and followed up to 12 months, health plan disenrollment, or death. Cost was measured as that incurred during the initial episode plus subsequent follow-up or during the subsequent follow-up only. Patients were dichotomized as high-cost (top 20%) or low-cost (bottom 80%), based on total costs. Logistic regression was used to examine the association for being classified as high-cost. RESULTS: A total of 13 731 patients were included: 51.7% with UA, 39.6% with AMI and 8.7% with both UA and AMI. The mean age was 54.2 years and 68.2% were male. A number of co-morbidities (hypertension, diabetes, heart failure, etc.) predicted high-cost patients. Among medications, prior ACE inhibitor use predicted high-cost patients. While revascularization procedures, in general, were strong predictors of high-cost, revascularization during the index ACS episode (opposed to revascularization during the follow-up) decreased the odds of being high-cost (odds ratio [95% CI] 0.615 [0.506-0.748]). CONCLUSION: High-cost patients with new onset ACS can be predicted by some characteristics, but many of these characteristics are non-modifiable co-morbidities. Payers and providers may find opportunities for clinical and cost-saving interventions for these patients.     

Quantification of regional left ventricular systolic dysfunction in patients with coronary artery disease by pulsed Doppler tissue imaging

OBJECTIVES: To analyze and compare quantitatively regional myocardial functional abnormalities of the left ventricle by pulsed Doppler tissue imaging (DTI) in patients with unstable angina (UA) and prior myocardial infarction (MI), and to explore the value of systolic velocity and time intervals in evaluating regional left ventricular systolic dysfunction. METHODS: Patients with coronary artery disease (CAD) were divided into UA (16 cases) and anterior wall MI (ant-MI, 21 cases) groups. Sixteen age-matched normal subjects served as the control group. The septal and lateral, anterior and inferior walls of the left ventricle were displayed, and basal and middle segments of each wall were selected for myocardial motion spectrum sampling. DTI parameters were: peak systolic myocardial velocity (s), regional pre-ejection period (PEP), time to peak of the systolic wave (Ts), regional ejection time (ET) and PEP/ET ratio. RESULTS: Compared with the control group, s was significantly lower in all segments in the ant-MI group, and in lateral and anterior segments in the UA group. It was even lower in the ant-MI than in the UA group, and in infarct compared with corresponding non-infarct segments in the ant-MI group. PEP and Ts were significantly longer in both the UA and the ant-MI groups. CONCLUSION: Not only s, but also PEP and Ts as measured by pulsed DTI are sensitive markers of regional left ventricular systolic dysfunction in patients with CAD; s and PEP may even indicate the severity of myocardial ischemia and aid in estimating the site of MI.     

急性心肌梗塞患者血浆内皮素水平变化的意义

动态观察２８例急性心肌梗塞患者血浆内皮素及血清肌红蛋白水平的变化，并同时选择１３例不稳定心绞痛患者和１５例健康人做对对照。结果表明、ＡＭＩ组血中ＥＴ及Ｍｂ水平平均于梗塞２４小时之内达峰值，且随病程延长而逐渐下降，７天后降至正常范围；ＡＭＩ组血浆ＥＴ水平显著高于ＵＡ组及正常组，其中ＵＡ组又明显高于正常组；