腺苷心肌灌注断层显像诊断老年人冠心病的价值

目的 探讨腺苷负荷试验锝-甲氧基异丁基异腈(~(99m)Tc-MIBI)心肌灌注单光子发射计算机断层显像(ECT)诊断老年人冠心病的价值. 方法 53例无心肌梗死病史的老年冠心病待查患者,年龄60～78岁,平均(65.5±6.5)岁.将ECT和冠状动脉造影(CAG)结果进行对照. 结果 ECT对CAG阳性冠心病诊断的敏感性为73.7%,特异性90.9%,阳性预测值为94.3%,阴性预测值为80.0%,准确性指数为62.3%.结果显示,腺苷ECT对左前降支、回旋支、右冠状动脉检出的特异性分别为90.9%、85.7%、100%,阳性预测值分别为73.5%、77.3%、72.0%. 结论 腺苷是一种较强的血管扩张剂,对心血管系统有多重作用.其与导管技术、核素心肌灌注显像等技术结合可用于冠心病的诊断.腺苷介入心肌灌注断层显像是一种无创、方便、费用低的检查方法,对老年冠心病的诊断、指导治疗和判断预后有重要的意义.

The diagnostic value of adenosine myocardial perfusion single photon emission computed tomography in elderly patients with coronary artery disease

Objective To evaluate the diagnostic value of adenosine stress ~(99m)Tc-MIBI myocardial perfusion single photon emission computed tomography (ECT)in elderly patients with coronary artery disease (CAD). Methods Fifty-three patients aged ≥60 years without the history of myocardial infarction were included in the research. The average age of the patients was(65.5±6.5) years (60-78 years old). All patients underwent adenosine stress ~(99m)Tc- MIBI myocardial perfusion single photon ECT and coronary angiography (CAG) within 2 months, and the results were compared. Results Compared with CAG, the sensitivity, specificity, positive predictive value, negative predictive value and accurate index of ECT were 73.7%, 90.9%, 94.3%, 80.0% and 62.3%, respectively. The specificity for left anterior descending artery, left circumflex artery and right coronary artery of ECT were 90.9%, 85.7% and 100%, respectively, and the positive predictive values were 73.5%, 77.3% and 72.0%, respectively. Conclusions Adenosine is a strong vasodilator and it has multiple effects on cardiovascular system. Combination of angiocardiography and myocardial perfusion imaging can be used in diagnosis of coronary artery disease. ECT is a noninvasive, convenient and low cost method and plays an important role in diagnosing, directing treatment and judging prognosis of CAD in the elderly patients.