门控心肌断层显像临床应用的初步报道

本文报道了对5例正常人和69例各类心脏疾病患者所做的门电路心肌断层显像(GSPECT)与一般心肌断层显像(SPECT)相比较的初步分析研究。结果表明；静息显像时，GSPECT与SPECT在正常人组均表现为阴性，在冠心病组的阳性率为43．5%与30．4％，心肌梗塞组为100％与87．5%。应激试验时，GSPECT与SPECT在正常人组均表现为阴性，在冠心病组的阳性率为6／6与5／6，心肌梗塞组4／4与4／4。对于心肌病患者，GSPECT和SPECT则表现为阴性或心肌放射性分布稍稀疏或斑点状的不均匀分布。至于其他的心脏疾病，GSPECT和SPECT则大多表现为阴性。     

99mTc-MIBI心肌灌注断层显像与冠状动脉造影在冠心病诊断中的对比研究

目的：研究放射性核素心肌灌注显像与冠脉造影在冠心病诊断中的相互关系，应用多巴酚丁胺（DBT）介入心肌灌注断层显像（SPECT）检出提高对冠心病诊断灵敏度。方法：对65例行冠脉造影及药物介入SPECT两项检查者影像分析，应用阅片计分法评价SPECT对冠心病诊断灵敏度、特异度及对病变血管检出的灵敏度。结果：65例585个节段中，42例静息显像检出175个异常节段，另23例多巴酚丁胺（DBT）介入试验后显像又检出33个异常节段。静息显像诊断冠心病灵敏度为84％，DBT介入后为96％；而特异度均为66．7％。诊断符合率静息显像80％，DBT介入后约89．2％。对病变血管检出灵敏度与病变血管支数有关，单支93．3％，双支84．2％，三支56．3％；与病变血管有关，前降支（LAD）89．6％，右冠脉（RCA）81％，左旋支（LCX）59．4％，而与狭窄程度无明鹕相关。结论：SPECT对冠心病诊断有较高灵敏度和特异度，与冠脉造影（CAG）结合利于检了“罪犯”血管。DBT介入显像可提高冠心病诊断及“罪犯”血管检出率。     

硝酸甘油介入99^mTc-MIBI心肌灌注显像诊断冠心病及估测心肌存活性的价值

目的：评价硝酸甘油介入99^mTc-MIBI心肌灌注显像（SPECT）诊断冠心病及估测心肌存活性的价值。方法：48例可疑冠心痛患者，于冠状动脉造影（CAG）术前1周内行静息、硝酸甘油介入99^mTc-MIBI心肌SPECT检查，以CAG为金标准，观察硝酸甘油介入99^mTc-MIBI心肌SPECT诊断冠心病的准确性。对于25例成功行经皮冠脉介入治疗（PCI）的冠心病患者，以PCI术后3个月室壁运动改善为检验标准，评价硝酸甘油介入99^mTc-MIBI心肌SPECT检测存活心肌的应用价值。结果：硝酸甘油介入99^mTc-MIBI心肌SPECT诊断冠心病的敏感性、特异性、准确性分别为83．9％、76．5％、81．3％，评价存活心肌的敏感性为91．8％，准确性为84．9％。结论：硝酸甘油介入99^mTc-MIBI心肌SPECT在诊断冠心痛及估测心肌存活性有较高的临床应用价值。     

^18F-FDG符合线路SPECT/CT显像在肺癌中的应用价值

目的：探讨^18F-FDG符合线路SPECT/CT显像在肺癌诊断和淋巴转移探查中的价值.材料与方法：57例疑似肺癌患者进行18F-FDG符合线路SPECT/CT显像,以术后病理结果作为金标准,判断^18F-FDG符合线路SPECT/CT显像诊断肺癌的灵敏度、特异性、假阴性率、假阳性率及符合率.结果：57例患者中,符合线路SPECT/CT显像诊断肺癌的灵敏度为95.92％（47/49）,特异性为75％（6/8）,假阳性率为25％（2/8）,假阴性率为4.08％ （2/49）及符合率92.98％（53/57）.47例真阳性病例中,^18F-FDG符合线路SPECT/CT显像提示淋巴结及其他脏器转移者为82.98％（39/47）.结论：符合线路SPECT/CT显像对肺癌定性诊断的灵敏度高,特异性好,对淋巴结转移及其他脏器转移灶的探查有很好的价值,可为确定临床分期、制定治疗方案及判断预后提供有益的参考.     

冠心病患者血浆D－二聚体含量的研究

采用ＥＬＩＳＡ法测定６０例冠心病患者和２０例健康人血浆Ｄ－二聚体（ＤＤ）的含量。结果显示：（１）急性心肌梗塞（ＡＭＩ）组和陈旧性心肌梗塞（ＯＭＩ）组血浆平均ＤＤ值分别与对照组相比有显著性差异（Ｐ＜０．００１，Ｐ＜０．０１）。（２）ＡＭＩ组的血浆平均ＤＤ伍分别与ＯＭＩ组、心绞痛组、隐性冠心病组相比也有显著性差异（Ｐ＜０．００５）。（３）冠心病组中共有３８例血浆ＤＤ含量异常增高，其中５８％为心肌梗塞患者。ＡＭＩ组和ＯＭＩ组血浆ＤＤ异常申分别与对照组相比，有显著性差异（Ｐ＜０．００５，Ｐ＜０．０２５）。提示心肌梗塞患者体内纤溶系统处于活跃状态。因此，血浆ＤＤ含量的测定可作为心肌梗塞诊断的辅助指标之一，尤其是ＡＭＩ患者血浆ＤＤ含量升高更为明显且阳性率也最高。     

单光子发射计算机断层成像在轻中型颅脑损伤评估及预后中的应用

目的：探讨单光子发射计算机断层成像（SPECT）在轻、中型颅脑损伤（TBI）早期评估及预后判断方面的价值，为临床功能评估及预后估计提供有价值的依据。方法：24例轻中型颅脑损伤患者受伤2周内行SPECT，CT检查及临床评定，3个月所有患者行脑外伤后综合征的临床测试，并对首检SPECT阳性者复与预后的关系。结果：（1）24例轻中型颅脑损伤首检SPECT阳性率71％，高于CT阳性率46％（P＜0．05），（2）首检SPECT发现阳性病灶48处，高于CT的21处，且分布范围广，（3）首检SPECT阳性预测率59％，阴性预合征；另9例（53％），结论：（1）在轻中型颅脑损伤的早期评估中，SPECT显像较CT扫描更灵敏。（2）SPECT阳性率与脑损害程度相关，（3）首检SPECT阴性提示预后良好，复检SPECT阳性提示多出现脑外伤后综合征。（4）首检SPECT阳性尚不足以估计患者预后。     

心电图运动负荷试验在冠心病诊断中的价值

目的：探讨心电图踏车运动试验对冠心病的诊断价值。方法：102例男性与48例女性心电图踏车运动试验结果与冠状动脉造影结果进行对比分析。结果：心电图踏车运动试验诊断冠心病的敏感性73．5％（50／68），特异性82．9％（68／82），准确性78．7％（118／150）。多支冠状动脉病变患者心电图踏车运动试验阳性率显著高于单支病变P〈0.01。中高危人群心电图踏车运动试验的阳性率38．8％，冠状动脉造影阳性率52．9％；低危人群心电图踏车运动试验的阳性率10．3％，冠状动脉造影阳性率13．8％，两组人群的阳性率有显著性差异，P〈0．01。女性运动试验假阳性率高于男性（分别为29％和9．8％，P〈0．05）。结论：简便、易行和无创伤的心电图踏车运动试验是评价心肌缺血和协助诊断冠心病的重要手段，结合冠心病的易患因素综合分析，对确诊冠心病拟诊患者有重要的参考价值，同时可为选择适合行冠状动脉造影的高危患者提供重要依据。     

频域心电图(FCG)在诊断冠心病中的应用

近年来，我院使用FCG对129例冠心病（CHD）进行检查，结果提示FCG对冠心病的诊断具有较好的参考价值，现报告如下。1资料与方法CHD组共129例，均具有典型心绞痛和／或缺血型（ECG、VCG）改变。其中无心肌梗塞组116例，男性94例，女性22例，平均年龄62．9±69岁；陈旧性心肌梗塞（OMI）组13例，男性11例，女性2例，平均年龄67．1±8．23岁。对照组66例，男性53例，女性13例，平均年龄47．12±12．76岁，经临床体检、ECG、VCG、2D超声心动图及X线检查，排除心血管疾病。检查采用WEX公司HD－3L多功能心电分析仪，给受检者接受常…     

左室腔与心肌计数比值对心肌梗塞患者预后的预测价值

目的：探讨^99mTc－MIBI静息心肌断层显像左室腔与心肌计数比值（C／M比值）对心肌梗塞（MI）患者预后的预测价值。方法：74例行静息心肌显像的心肌梗塞患者按C／M比值分为C／M比例减低组和正常组,并对其进行随访,随防时间平均为23月。未发生心脏事件者随访时间≥12月。心脏事件包括：心源性死亡、非致死性心肌梗塞,心肌显像3月后的血运重建术（CABG或PTCA）。结果：74例心肌梗塞患者中C／M比值减 41例,C／M比值正常33例,随访期间发生心脏事件分别为18例（43．9％）,5例（15／2％）,C／M比值减低的MI患者心脏事件发生率显著高于C。M比值正常值（P＜0．01）。Log-ranK统计分析两组未发生心脏事件率差异有显著性（P＜0．05）。Cox多元回归显示,C／M比值减低是发生心脏事件独立的影响因素（RR＝5．38,95％的可信限CI1．86－16．13,P＜0．01）。结论：^99mTc－MIBI静息心肌断层显像C／M比值对MI患者的预后判断有较重要的价值,C／M比值减低是估测心肌梗塞患者不良预后的独立指标。     

冠心病心肌梗塞与抗心磷脂抗体关系的探讨

目的：搪塞抗心磷脂抗全（ＡＣＬ）在冠心病特别是心肌梗塞中的意义。方法：应用ＥＬＩＳＡ法测定了冠心病（８０例）、心肌梗塞（３０例）、心房纤颤（２８例）和正常对照组血清中的ＡＣＬ。结果：冠心病患者ＡＣＬ的阳性率（２３．８％）明显高于正常对照组；而心肌要且ＡＣ斩阳性率（４０％显著高于非心肌梗塞组；心纤颤组ＡＣ斩阳性率与非房颤组针显著性差异。结论：ＡＣＬ存在于部分冠心病患者中，在心肌梗塞患者阳性率更高，说     

Early exercise thallium-201 single photon emission computed tomography in unstable angina: a prospective study

Summary. To evaluate the safety and diagnostic value of early symptom-limited exercise electrocardiography (ECG) and exercise thallium-201 single photon emission computed tomography (SPECT) in unstable angina (UA), 39 patients were studied prospectively soon after stabilization on medical treatment. No patient had a history of myocardial infarction (MI) or revascularization and patients with left bundle branch block were excluded. Exercise ECG and exercise thallium-201 SPECT were performed 8 plusmn; 4 days and 11 plusmn; 6 days respectively after admission to hospital. Seventeen out of 39 patients (44%) had positive exercise ECGs and 22 (56%) negative or inconclusive ones. Exercise thallium-201 SPECT was positive in 26 patients (67%) and negative in 13 patients (33%). Thirty-one patients underwent coronary arteriography and 24 of them proved to have significant coronary artery disease (CAD). The sensitivity, specificity and positive predictive value of exercise ECG in detecting CAD are 62%, 86%, and 94% respectively while the corresponding results are 96%, 100%, and 100% for exercise thallium-201 SPECT. Therefore, it is concluded that the early symptom-limited exercise test is safe in medically stabilized patients with UA. Early exercise thallium-201 SPECT is highly sensitive and predictive of the presence of significant CAD among patients in the early recovery phase of UA and can be used in selecting this group of patients for coronary angiography and other therapeutic strategies.     

99mTc-MIBI心肌断层显像与冠状动脉造影诊断冠心病的对比分析

目的:探讨99mTc-MIBI心肌断层显像(SPECT)诊断冠心病(CAD)的临床价值。方法:60例患者同时进行99mTc-MIBI心肌断层显像(SPECT)和冠状动脉造影(CAG)检查,将结果进行对比分析。结果:以CAG为标准,SPECT诊断冠心病的敏感性93·18%,特异性50%,准确性指数81·67%,阳性预测值83·67%,阴性预测值72·73%。结论:SPECT与CAG从不同的角度诊断CAD符合率高。若CAG阳性则冠心病诊断成立,CAG与SPECT均阴性,可排除冠心病。     

冠状动脉造影在女性冠心病患者中的诊断价值

目的探讨冠状动脉造影对女性冠心病患者的诊断价值。方法对57例女性疑诊冠心病的患者行冠状动脉造影,以冠状动脉造影结果为判断冠心病的诊断标准。同时与体表心电图、临床表现及男性患者作对比分析。结果女性患者冠状动脉造影结果阴性率为40.35%,阳性率为59.65%,阴性率较男性（22.03%）为高（P〈0.01）,且主要为单支病变,前壁心电图改变阳性率为78.78%,有典型心绞痛表现者阳性率更高。结论女性患者冠状动脉病变相对较轻,临床冠心病误诊率较高,对疑似冠心病患者应尽早行冠状动脉造影。     

单纯心电图ST-T改变在老年患者冠心病诊断中的实际意义

目的评价心电图ST-T改变在诊断老年患者冠心病中的意义。方法选取2010年1月至2012年12月临床常规行心电图检查发现ST-T改变的患者180例,其中男90例,女90例,年龄60～86岁,平均(65.50±6.32)岁,70岁以上者136例(75.6%)。依据临床是否有典型心绞痛发作分为典型心绞痛组85例和不典型心绞痛组95例,所有患者入院前均在他院完成常规冠状动脉造影检查,入院后均积极完善各项常规检查,排除肝、肾等重要脏器疾患。结果典型心绞痛组中冠状动脉管腔直径狭窄≥50%者依据心电图检查ST-T改变,诊断阳性者为60例,心电图阳性检出率为70.59%;不典型心绞痛组冠状动脉管腔直径狭窄≥50%者依据心电图检查ST-T改变,诊断阳性者29例,心电图阳性检出率为30.52%。结论单纯心电图ST-T改变对诊断老年患者冠心病的临床实际价值不大,需通过进一步的检查来协助明确诊断,必要时行冠状动脉造影检查。     

彩色室壁动力技术多巴酚丁胺负荷试验在冠心病诊断中的应用

目的⑶探讨彩色室壁动力技术超声心动图对冠心病⒉ Ｃ Ａ Ｄ⒕患者室壁缺血部位检测的准确性和可靠性⒚方法⑶对拟诊或疑为冠心病者及正常人 ４０ 例全部进行 Ｃ Ｋ 超声心动图多巴酚丁胺负荷试验 ⒉ Ｃ Ｋ Ｄ Ｅｃｈ ｏ⒕⒙然后再与冠脉造影结果进行对照⒚结果⑶ Ｃ Ｋ Ｄ Ｅｃｈ ｏ 对于冠脉造影阳性、阴性组患者的诊断预测值分别为 ９１３０％ 、１００％ ⒙总预测值为 ９３９４％ ⒚其诊断 Ｃ Ａ Ｄ 的敏感性、特异性和准确性分别为 １００ ％ 、８３３３％ 和 ９３９４％ ⒚通过对心室壁缺血部位的观察⒙应用 Ｃ Ｋ 技术能够提高心内膜的显示率⒙避免人为因素⒙客观地做出室壁位移的时间值定量⒙明显优于二维超声法⒚结论⑶ Ｃ Ｋ Ｄ Ｅｃｈ ｏ 为 Ｃ Ａ Ｄ 诊断提供了一种安全、可靠的方法⒚     

不同联合检查方法对无症状心肌缺血患者冠状动脉病变程度的诊断价值

目的比较运动平板试验、动态心电图、超声心动图两两联合检查对无症状心肌缺血患者冠状动脉病变程度的诊断价值。方法选取80例无症状的疑似冠心病患者为研究对象,患者均进行运动平板试验、动态心电图、超声心动图和冠状动脉造影检查,以冠状动脉造影检查结果为金标准,比较运动平板试验联合超声心动图法(A联合法)、动态心电图联合超声心动图法(B联合法)、动态心电图联合运动平板试验法(C联合法)对无症状心肌缺血患者冠状动脉病变程度的诊断价值。结果冠状动脉造影检查结果显示,阳性(冠心病)患者45例,其中轻度狭窄12例、中度狭窄22例、重度狭窄11例;C联合法的诊断敏感性、阴性预测值分别为97.78%、96.30%,高于B联合法、A联合法,差异有统计学意义(P<0.05);B联合法、A联合法对轻度狭窄的检测阳性率均为41.67%,低于对中度狭窄和重度狭窄的检测阳性率,差异有统计学意义(P<0.05);C联合法对不同程度冠状动脉狭窄的检测阳性率比较,差异无统计学意义(P>0.05)。结论动态心电图联合运动平板试验对无症状心肌缺血具有较高的诊断价值。     

Clinical predictors of 30-day cardiac events in patients with acute coronary syndrome at a community hospital

OBJECTIVE: We sought to determine predictors of coronary events (cardiac death, acute myocardial infarction, and urgent revascularization) within 30 days after admission. METHODS: We prospectively collected data on 400 patients admitted through our emergency room for unstable angina and acute coronary syndromes. Patients with ST-segment elevation myocardial infarction and those who required thrombolysis were excluded. RESULTS: Of 383 patients who were eligible, 120 patients had coronary events within 30 days. Statistically significant variables associated with coronary events were advanced age, male sex, family history of premature coronary artery disease (CAD), diabetes mellitus, tobacco abuse, prior congestive heart failure, prior myocardial infarction, and history of CAD. Symptoms at presentation associated with cardiac events were typical angina and shortness of breath. Objective measures of ischemia associated with cardiac events were elevated troponin T, elevated creatine kinase MB, and ischemic electrocardiographic changes. Using forward stepwise regression analysis, we generated a model to predict 30-day major adverse cardiac events. The strongest predicting variable was serum troponin T (accounting for 33% of predicting r2, P < 0.001) followed by typical angina (r2 increasing to 37%), ischemic electrocardiographic changes (40%), prior CAD (42%), family history of premature CAD (44%), shortness of breath (46%), and positive creatine kinase MB (48%). The positive predictive power of the complete model was r2 = 48%, P < 0.001. CONCLUSION: Our model incorporating elements from the patient's demographic, medical history, presentation, and ischemic assessment identified 48% of patients presenting with unstable angina and acute coronary syndromes who will suffer a major adverse cardiac event within 30 days of admission. Although the strongest predictor was identified as serum troponin T, other clinical criteria offered improvement in our predictive abilities. Therefore, good initial clinical evaluation in addition to simple tests such as serum cardiac markers and electrocardiography are valuable in risk stratification of patients presenting with acute coronary syndromes and cardiac chest pain. Additional testing may be necessary to improve the positive predictive value of the model. Cardiac enzymes and electrocardiographic changes have the highest negative predictive value for occurrence of major adverse cardiac events. Identification of high-risk patients is essential to direct resources toward these patients and to avoid unnecessary costs and risk to the low-risk population.     

同步等负荷运动心电图、二维超声心动图及心肌灌注断层显像对冠心病的诊断价值

评价等负荷运动心电图(运动ECG)、二维超声心动图(2-DE)及心肌灌注断层显像(ECT)的单项试验和三项联合应用对冠心病的诊断价值。对28例冠脉造影阳性(冠心病组)和18例冠脉造影阴性(正常组)患者进行同步等负荷运动ECG、2-DE及ECT试验。运动ECG、2-DE及ECT对冠心病诊断的敏感性分别为82.1％、71.4％及96.4％;特异性为77.8％、88.9％及55.6％。在冠心病组三项负荷试验均阳性者占64.3％,二项阳性者占28.6％,而一项阳性者仅为3.6％;在正常组三项试验均阳性者占11.1％(临床为X综合征),二项阳性者为0,一项阳性者占38.6％,三项阴性者占50％。三项负荷试验均阳性诊断冠心病的可靠性最大,二项阳性有诊断冠心病的可能,一项阳性诊断冠心病的可能性小,阳性意义需结合临床考虑,三项阴性者可排除冠心病。     

Results of dipyridamole plus atropine echo stress test for the diagnosis of coronary artery disease

Sensitivity of dipyridamole stress echocardiography (DIP-E) has been reported to be less than ideal in particular subsets of patients such as those with less severe extent of coronary artery disease (CAD). To verify if sensitivity could be improved, ATRO (1 mg in 2 minutes) was added at the end of a negative high-dose (0.84 mg/kg over 10 minutes) DIP-E in 61 consecutive patients (58 men, aged 53±7 years) evaluated for chest pain (33%) or for detection of residual ischemia after acute myocardial infarction (AMI) or previous MI (67%). DIP-E was positive in 28/61 (46%) and negative in 33/61 (54%) patients. Additional echo positivity was obtained in 18/33 (54%) patients after ATRO. Coronary arteriography was normal in 6 patients (10%); 1-vessel CAD was diagnosed in 28 (46%), 2-vessel CAD in 16 (26%) and 3-vessel CAD in 11 (18%) cases. The sensitivity for CAD diagnosis was 49% (27/55) for DIP-E and 84% (46/55) for DIP-E + ATRO (p<0.001). Specificity was 83% and 80%, respectively. Diagnostic accuracy increased from 52% to 83% (p<0.001). The better diagnostic accuracy of DIP-E was mainly related to the significant increase in sensitivity of the combined test in patients with 1-vessel CAD (from 46% to 75%) (p<0.005). At quantitative coronary evaluation, compared to patients with positive DIP-E + ATRO or negative DIP-E + ATRO test, patients with positive DIP-E had a higher mean % diameter stenosis: 80±13% vs 72±24% and 65±36%, respectively. Peak heart rate was significantly higher after the addition of ATRO vs basal and DIP alone in patients with a positive DIP-E + ATRO test. The addition of ATRO to DIP increases diagnostic accuracy of DIP-E particularly in patients with less severe extent of CAD; ATRO may be considered as a useful routine procedure for increasing diagnostic value of DIP-E test.     

不同类型冠心病患者血浆游离脂肪酸水平变化及其与病变程度的关系

目的探讨血浆游离脂肪酸(NEFA)水平变化与冠心病(CAD)病变程度的相关性。方法选取疑为CAD患者84例,分别行生化检验和冠状动脉造影检查;根据冠状动脉造影结果将其分为4组,分别为不稳定型心绞痛组(n=46)、稳定型心绞痛组(n=9)、急性心肌梗死组(n=20)、阴性对照组(n=9),对比组间血脂指标与NEFA是否存在差异分析,CAD患者发生急性心肌梗死风险与造影特点。结果 CAD组NEFA水平均高于阴性对照组,差异有统计学意义(P0.05);急性心肌梗死组NEFA水平高于稳定型心绞痛组和不稳定型心绞痛组,差异有统计学意义(P0.05);Logistic回归分析显示,校正后NEFA≥0.415mmol/L组出现急性心肌梗死的风险是NEFA0.415mmol/L组的2.61倍,95%CI:1.33~5.02,P0.05;不同水平的NEFA患者GENSINI积分、狭窄冠状动脉支数与3支冠状动脉病变数量差异无统计学意义(P0.05)。结论 CAD患者血浆NEFA出现升高,急性心肌梗死患者升高明显,但其与病变程度相关性未明确。