99Tcm -DMP444肺动脉血栓与下肢深静脉血栓显像的实验研究

目的 探讨小分子多肽血栓显像剂99Tcm-邻苯二甲酸二甲酯(DMP) 444在PE和下肢深静脉血栓(DVT)动物模型中的显像效果.方法 选5条杂种犬,制备左下肺动脉血栓和右股静脉血栓动物模型.注射显像剂后即刻(30 s)、2、3、4、5、10、15、30、60、90和120 min分别取静脉血1ml,测质量及放射性计数.以注射后即刻的血液放射性计数为100％,计算各时间点的99Tcm-DMP444血液清除率.注射后15、30、60、90和120 min,分别进行胸部及双后肢平面显像.应用ROI方法,分别计算肺血栓/肺本底(P/L)、股静脉血栓/对侧股静脉血(D/B)和股静脉血栓/肌肉本底(D/M)的放射性比值.显像结束后,取出血栓分别测定肺动脉血栓和股静脉血栓摄取99Tcm-DMP444的％ID/g.不同时间点均数之间的差异采用单向重复测量方差分析.结果 99Tcm-DMP444注射后120 min的血液清除率为(65.4±3.9)％.左下肺动脉及右股静脉血栓部位放射性摄取随时间逐步增强,注射后15至120 min,P/L,D/B和D/M比值分别从2.41±0.28、1.67±0.33、2.20±0.14增加至3.96±0.64、2.56±0.57、3.90±0.95,差异均有统计学意义(F=14.57、7.68和9.37,P均＜0.05).PE和后肢DVT的％ID/g分别为0.085±0.023和0.054±0.018.结论 99Tcm-DMP444能无创性地早期检测急性PE和下肢DVT,是较为理想的小分子多肽血栓显像剂.     

超声弹性成像在胆道闭锁患儿中的应用进展

胆道闭锁是婴儿持续性黄疸常见病因,可快速发展为胆汁性肝硬化,甚至导致死亡。胆道闭锁肝纤维化程度与肝门空肠吻合术术前评估、术后追踪及选择肝移植时间点密切相关。超声弹性成像是无创评价肝纤维化程度较有前景的技术之一。本文就超声弹性成像技术在胆道闭锁中的应用进展进行综述。     

99Tcm-TF与99Tcm-HL91心肌乏氧显像评估SMI心肌活力进展

SPECT心肌灌注显像是评价冠心病心肌缺血的无创方法.99Tcm-TF作为新型心肌显像剂,标记简便无需水浴,本底清除快,有效缩短待检时间,诊断心肌缺血/梗死效果佳,但低估了心肌细胞的活性.18F-FDG PET心肌显像是评判心肌活力有效方法,但因其普及率低、费用昂贵,存在一定的检查失败率等因素而无法广泛使用.99Tcm-HL91是近年来研制的乏氧组织显像剂,能直接与乏氧心肌组织结合,乏氧心肌显著摄取,正常心肌摄取少,坏死心肌不摄取.SMI是冠心病发生发展过程中的一种表现,是冠心病其最危险的因素之一,但又常被忽视.SMI患者行99Tcm-TF联合99Tcm-HL91乏氧显像,对心肌缺血范围、严重程度及心肌活力的判断、合理治疗方案的选择、预后疗效的判定及减轻患者综合医疗负担等方面均有积极作用.     

放射性核素131I在甲亢治疗中的应用现状和进展

以Graves病为代表,探讨放射性核素131I在甲亢治疗学中的应用,归纳、总结和讨论131I在甲亢治疗中的适应症、剂量、联合治疗、疗效和转归.与传统治疗方法相比,131I治疗甲亢具有快速简便、不良反应少、治疗效果好、费用低等优点,逐渐成为甲亢治疗的主流方法,但治疗时需注意向甲减的转归.     

利可君在放射性核素内照射治疗疾病中预防骨髓抑制作用

放射性核素靶向治疗是治疗恶性肿瘤及其他一些常见疾病的重要手段之一,但也有可能由于电离辐射生物效应同时造成骨髓抑制副反应.临床解决骨髓抑制的主要方法为口服或注射升白药物,最为常见的口服用药为利可君,化学性质独特,具有稳定升高白细胞水平以及一定的抗癌作用.在131Ⅰ治疗甲亢、甲状腺功能自主毒性腺瘤和大剂量131Ⅰ治疗甲癌术后残留、局部复发或远处转移的患者配合使用利可君可有效预防骨髓抑制或提高白细胞水平.     

Oral OPC-8212 for the treatment of congestive heart failure: Hemodynamic improvement and increased exercise capacity

Summary The chronic effects of the oral administration of OPC-8212 (3,4-DIHYDRO-6-[4-(3,4-dimethoxybenzoyl)-1-piperazinyl]-2(1H)-quinolinone) on resting hemodynamics and exercise capacity were assessed in 15 patients with congestive heart failure (NYHA II–IV). Doses of 30 or 60 mg per day were given per os over 3.0 weeks on average (range 2–6 weeks). Multigated radionuclide ventriculography and multistage exercise testing were performed before and during OPC-8212 therapy to assess the changes in left ventricular volume and exercise capacity respectively. Systolic blood pressure showed a slight increase (from 123±3 to 129±4 mmHg) during OPC-8212 therapy, while heart rate was unchanged (69±3 vs 67±3 beats/min). The left ventricular end-diastolic volume index decreased from 127±9 to 107±7 ml/m², and ejection fraction and the P/V index (the ratio of peak systolic pressure to left ventricular end-systolic volume index) increased during OPC-8212 therapy (from 27%±3% to 30%±4% and from 1.5±0.2 to 2.0±0.3 mmHg/ml/m² respectively). NYHA functional class was improved in 9 of 15 patients, and the average peak work load achieved during exercise testing increased from 27±6 to 47±7 W. No significant adverse effect was observed in any patient. These results indicate that OPC-8212 enhances the inotropic state and, hence, reduces heart size with no change in heart rate. Moreover, it increases exercise capacity. Thus, OPC-8212 is an inotropic agent with promise for application in the long-term treatment of congestive heart failure.     

肺、心导纳血流图联合应用对左室舒张功能的诊断价值

目的　是以核素心室造影 (简称 :心血池 )的PFR(峰充盈率 )及LVEF(左室射血分数 )为对照 ,探讨心、肺导纳图联合应用对左室舒张功能的诊断价值。方法　 118例研究对象包括健康对照 30人 (男性 18人 ,女性 12人 ,平均年龄 5 4 4岁± 7 8岁 ) ;高血压和 /或冠心病 (心绞痛、陈旧心梗 )病人 89人 ,后者依心血池的PFR及LVEF结果分为 :心功能正常组 (PFR≥ 2 0 ,LVEF≥ 5 0 % ) 19人 (男 12人 ,女 7人 ,平均年龄 5 4 8岁± 8 9岁 ) ;单纯舒张功能障碍组(PFR <2 0 ,LVEF≥ 5 0 % ) 30人 (男 19人 ,女 11人 ,平均年龄5 4 1岁± 8 8岁 ) ;舒张及收缩功能障碍组 (PFR <2 0 ,LVEF<5 0 % ) 39人 (男 2 4人 ,女 15人 ,平均年龄 5 4 4岁± 9 7岁 )。99mTcPYP示踪剂 ,平衡法测LVEF、PFR、HR。同一天内进行机测心导纳的LVEF、肺导纳的Ha(房缩波a波高度 )、HS(室宿波S波高度 )、HD (室舒波D波高度 )、Ha/HS和HD/HS比值。比较病人各组各参数与健康对照组的差别 ,肺导纳各参数与PFR的相关系数 ,心、肺导纳图联合应用对左室功能的诊断符合率。结果　①与健康对照组相应参数比较 ,心功能障碍的病人组Ha、HD、Ha/HS、HD/HS均明显增高。②全部研究对象的Ha、HD、Ha/HS、HD/HS与PFR呈负相关分别为 - 0 .6 93,- 0 .4 5 7,     

Left ventricular performance and autonomic dysfunction in patients with long-term insulin-dependent diabetes mellitus

Cardiac autonomic neuropathy (CAN) is a very frequent complication of insulin-dependent mellitus type 1, affecting the sympathetic or parasympathetic sections or both. The different impairment in the two sections might modify left ventricular function early. To evaluate this relationship, we studied 61 patients (mean age 39.6±7 years) with type 1 diabetes for more than 10 years, without coronary artery disease (CAD; negative ergometric stress test) and without other pathologies that could interfere with ventricular function. All patients underwent MONO-, 2-dimensional and Doppler echocardiographic examination and radionuclide angiography with⁹⁹Tc (RNA). According to the outcome of the Ewing tests, patients were divided into two groups: group A with two or more tests altered (26 patients with CAN) and group B with one or no tests altered (35 patients without CAN). No significant differences between the two groups were found in the systolic function parameters with either technique. In contrast, a pattern of abnormal relaxation was found for the diastolic function parameters: in group A a decrease in E-wave velocity and its time-velocity integral and an increase in A-wave and its time-velocity integral were detected with echocardiography. Moreover, RNA showed a reduced peak filling rate and an increased isovolumic relaxation time. When compared with normal values, an abnormal diastolic filling, defined as two independent echocardiography plus one RNA variable impairment, was found in 15 patients (57.6%) in group A and in only 4 patients (11.4%) in group B (P<0.001). Our findings suggest an early involvement of diastolic function in patients with CAN.