盐酸去甲乌药碱负荷99Tcm-MIBI心肌灌注显像在冠心病诊断中的价值

目的 评估盐酸去甲乌药碱(HG)负荷MPI对冠心病的诊断价值.方法 62例疑诊冠心病患者行HG负荷-静息99Tcm-MIBI MPI和CAG.以CAG结果为“金标准”,计算HG负荷显像诊断冠心病的灵敏度、特异性准确性、阳性预测值和阴性预测值.结果 以冠状动脉(简称冠脉)主支或其一级分支狭窄≥50％作为诊断标准,62例患者中CAG阳性38例(61.3％),阴性24例(38.7％)；阳性者中单支病变24例,双支病变9例,三支病变5例.CAG阳性者中HG负荷显像异常22例；阴性者中HG负荷显像正常者22例.HG负荷显像诊断冠心病的灵敏度为57.9％(22/38),特异性为91.7％(22/24),准确性为71.0％(44/62),阳性预测值为91.7％(22/24),阴性预测值为57.9％(22/38).62例患者显像时发生不良反应22例(35.5％),但均能在短时内缓解,完成检查.结论 盐酸去甲乌药碱负荷99Tcm-MIBI心肌显像对冠心病的诊断价值尚可,不良反应较少；该药有望成为MPI新型负荷药物.

Detection of coronary heart disease with ^99 Tcm.MIBI myocardial perfusion imaging stressed by intravenous infusion of higenamine hydrochloride

Objective To investigate the role of ^99Tcm-MIBI MPI stressed by intravenous infusion of higenamine hydrochloride （HG） in detection of coronary heart disease （CHD）. Methods Sixty-two pa- tients with suspected CHD underwent both ^99Tc^m-MIBI MPI with HG infusion and GAG. GAG was used as the gold standard in diagnosing CHD. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HG stress studies were evaluated with 99Tem-MIBI MPI. Results Using ste- nosis of the main branch or the first branch with more than 50% stenosis as the diagnostic criteria, 38 pa- tients （61.3%） showed abnormal CAG resuhs, including 24 one-, 9 two-, and 5 three-vessel stenoses. Of the 38 patients（38.7% ） with abnormal GAG results, positive results in HG MPI studies were demonstrated in 22 patients. Negative results in HG MPI studies were confirmed in 22 patients among the 24 patients with normal GAG results. For detection of CHD, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 99Tcm-MIBI MPI with HG infusion were calculated as 57.9% （22/38）, 91.7% （22/24）, 71.0% （44/62）, 91.7% （22/24） and 57.9% （22/38）, respectively. Twen- ty-two patients （35.5%） had side effects during HG stress studies, but no effects were severe. All patients recovered soon after examination. Conclusion An HG stress study is feasible and safe, and it is a potential method in detection of CHD with ^99Tc^m-MIBI MPI.