硝酸甘油酯介入~(99m)Tc-MIBI心肌断层显像与多巴酚丁胺负荷超声心动图判定存活心肌的比较

为比较硝酸甘油酯（ＮＴＧ）介入９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与小剂量多巴酚丁胺负荷超声心动图（ＤＳＥ）在判断急性心肌梗塞（ＡＭＩ）后病人存活心肌中的一致性，对３６例ＡＭＩ病人分别进行了ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像和小剂量（＜１０μｇ·ｋｇ－１·ｍｉｎ－１）的ＤＳＥ检查，所有检查均在病人入院后２～３周内完成。结果：在心肌静态显像示梗塞的１０９个节段中，ＮＴＧ显像４３个为存活节段，存活心肌检出率为３９％；在基础状态下超声心动图示梗塞的９４个节段中，ＤＳＥ检查３５个为存活节段，其存活心肌检出率为３７％，两者间差异无显著性（χ２＝０１０５，Ｐ＞００５）。在两法共同检出的９２个梗塞节段中，均存活的节段为２９个，均未存活的节段为４９个，两法的一致性为８４８％（７８／９２，Κ＝０６８）。因此，ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像与ＤＳＥ检查均为判断ＡＭＩ后病人存活心肌的安全、可靠的方法，两法具有良好的一致性。     

含服硝酸甘油后99mTc-MIBI心肌显像与201Tl再注射显像检测存活心肌的比较

目的观察硝酸甘油介入后心肌显像（ＭＢＮ）在预测经皮冠状动脉成形术（ＰＴＣＡ）后心室壁活动改善中的准确性，并与２０１Ｔｌ再注射显像（ＴｌＲＲ）结果进行比较。方法３１例心肌梗塞患者在２周内分别进行２０１Ｔｌ静息及再注射显像、９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）潘生丁介入及硝酸甘油介入心肌显像，将左心室心肌分成９个节段，应用周边剖面法定量分析左心室各节段放射性分布，并以左心室峰节段计数的百分率表达。结果在３１例患者共计１６２个异常节段中，ＭＢＮ及ＴｌＲＲ见有明确放射性摄取改善者分别为６１％及６４％（Ｐ＞００５）；以静息２０１Ｔｌ显像心肌各节段放射性分布值的高低分为４组，各组内ＭＢＮ及ＴｌＲＲ摄取值差异无显著性；在１３例完成显像后进行ＰＴＣＡ治疗的患者中，ＭＢＮ及ＴｌＲＲ对手术后心室壁活动改善的阳性预测率分别为８２％及７８％，阴性预测率分别为８８％及９０％，χ２检验两者差异无显著性。结论含服硝酸甘油介入９９ｍＴｃＭＩＢＩ心肌显像检测心肌梗塞区存活心肌具有与２０１Ｔｌ再注射显像相似的准确性，且方法简便实用，易于临床推广。     

^99mTc—MIBI心肌断层显像对急性心肌梗塞早期静脉溶栓的疗效观察

为观察急性心肌梗塞（ＡＭＩ）早期静脉溶栓的疗效，应用静态９９ｍＴｃ甲氧基异丁基异腈心肌断层显像，对２２例ＡＭＩ病人进行了观察。结果显示，９例溶栓再通病人由溶栓前平均９１±３３分降至３７±２２分（ｔ＝４０８５，Ｐ＜００１）。溶栓后２０个缺损节段中６个恢复正常，１０个明显改善。而这些节段为ＥＣＧ检查所示的梗塞部位。未溶栓组２次心肌显像变化不大。因此，静息心肌显像可观察ＡＭＩ病人溶栓前后心肌缺血有无改善，也可为判断冠状动脉再通提供影像学基础，具有一定的应用前景。     

多巴酚丁胺负荷及运动试验~(99m)Tc-MIBI心肌断层显像与冠状动脉造影的对比研究

比较６９例冠心病患者多巴酚丁胺负荷９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与８２例运动试验９９ｍＴｃＭＩＢＩ心肌断层显像的结果，以探讨它们对冠心病的诊断价值。结果表明：以冠状动脉造影结果为标准，多巴酚丁胺负荷诊断冠心病的敏感性和特异性分别为９１２％和８００％，运动试验分别为８９４％和８２９％。多巴酚丁胺负荷检出冠状动脉病变的敏感性和特异性：左前降支为７８１％和９１３％，回旋支为６６７％和９８２％，右冠状动脉为１００％和８３７％；运动试验分别为７８３％和９１１％，６００％和９６８％，９０９％和８５０％，差异均无显著性（Ｐ＞００５）。提示两者结果相近，对于不能进行运动试验的病人，多巴酚丁胺试验是一种有价值的诊断冠心病的方法。     

改良硝甘法介入99MTc-MIBI心肌显像判断存活心肌

目的评价改良硝酸甘油酯（简称改良硝甘法）介入９９ｍＴｃ甲氧基异丁基异腈心肌显像检测心肌梗塞后存活心肌的价值。方法分别对６５例改良组和３２例普通组的心肌梗塞患者进行了静息改良硝甘法介入和静息普通硝甘法介入心肌显像；两组中各有２８例和１２例行血管再通术，并于术后２～３个月重复静息心肌显像。结果改良组静息心肌显像检出灌注异常节段１９４个，改良硝甘法介入后有１２３个节段再填充，再填充率为６３４％；普通组静息显像检出灌注异常节段１０３个，普通硝甘法介入后有４８个节段再填充，再填充率为４６６％；两组差异有显著性（χ２＝７６６，Ｐ＜００１）。血管再通术患者术后复查静息心肌显像，与术前硝甘法介入显像比较，灌注改善的预测准确率为８９７％和７２２％。结论改良硝甘法介入可明显提高对存活心肌检测的灵敏度和特异性，且副作用小     

心肌显像剂~(99m)TcN(NOEt)_2的临床前药理研究

对心肌显像剂９９ｍＴｃＮ（ＮＯＥｔ）２（ＮＯＥｔ：Ｎ乙氧基，Ｎ乙基氨荒酸钠盐）进行了临床前药理研究，主要包括兔血药清除动力学，大鼠体内分布，狗显像及毒性等。制备的９９ｍＴｃＮ（ＮＯＥｔ）２放化纯度大于９０％，室温放置６小时稳定。分布半衰期＝２５３分钟，消除半衰期＝３３０分钟，清除率＝３７８ｍｌ／ｈ。药物能很快被大鼠心肌摄取并保留，５、３０、６０和９０分钟时分别为４６９、４２０、３９５和３４３％ＩＤ／ｇ，６０分钟时心／肺比值为１１６。狗显像显示９９ｍＴｃＮ（ＮＯＥｔ）２从肺中清除比心肌快，１０、３０和６０分钟时的心／肺比值分别为１６９、２４０和２５５，３０分钟心肌显像清晰，９０分钟全身显像显示心肌摄取为２８２％ＩＤ，但肝脏摄取高达３０１３％ＩＤ。小鼠对药物的耐受量为人的６１４倍。研究表明，９９ｍＴｃＮ（ＮＯＥｔ）２具有临床研究价值。     

^99mTc—抗人活化血小板嵌合McAb SZ—51Hu对狗动脉血栓放免显像

为了评价９９ｍＴｃ抗人活化血小板嵌合单克隆抗体（ＭｃＡｂ）ＳＺ５１Ｈｕ在血栓放射免疫显像（ＲＩ）中的应用价值，用９９ｍＴｃＳＺ５１Ｈｕ对狗动脉血栓模型进行了ＲＩ，并且与９９ｍＴｃ标记的原亲本鼠源性ＭｃＡｂＳＺ５１显像结果比较。结果表明，注射９９ｍＴｃＳＺ５１Ｈｕ后２～４小时血栓显示清晰。血液半清除时间：９９ｍＴｃＳＺ５１ＨｕＴ１／２α＝０３７±０２４小时，Ｔ１／２β＝８２３±３７０小时；９９ｍＴｃＳＺ５１Ｔ１／２α＝０６０±０１７小时，Ｔ１／２β＝９１７±４４４小时。显像结束后处死动物，离体血栓／血液和血栓／周围肌肉单位质量放射性比值：９９ｍＴｃＳＺ５１Ｈｕ为３３０５±７７８和２１０６８±１９２９７；９９ｍＴｃＳＺ５１为３６３３±５３０和２３４０２±７６９１。两组实验结果差异无显著性（ｔ＝０２７９９～１７３２２，Ｐ＞００５）。９９ｍＴｃＳＺ５１Ｈｕ保留了９９ｍＴｃＳＺ５１所具有的活体内导向定位血栓的能力，用于血栓性疾病的ＲＩＩ及导向治疗有一定的可行性。     

^99mTc—MIBI心肌断层显像肺摄取的定量分析

为评价＾９９ｍＴｃ＝甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像肺摄取定量分析对判断左心功能障碍的价值，４２例对照和６５例冠心病患者１周内完成＾９９ｍＴｃ－ＭＩＢＩ周内完成＾９９ｍＴｃ－ＭＩＢＩ心肌ＳＰＥＣＴ显像和核素心室显像。结果：对照组ＬＨＲ运动较静息时低（Ｐ〈０．０１）；冠心病组ＬＨＲ运动和     

硝酸异山梨酯介入~（99m）Tc－MIBI心肌断层显像在心肌存活判定中的价值

对３７例心肌梗塞患者进行９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）静态心肌显像，以及静脉给予硝酸异山梨酯（ＩＳＤＮ）后显像．静态心肌显像有１３４／３３３（４０．２％）个节段灌注异常，ＩＳＤＮ滴注后有５９／１３４（４４．０％）个节段心肌灌注得到改善．接受冠状动脉搭桥术患者术前ＩＳＤＮ显像改善的２０个节段，术后１７个（８５％）节段心肌灌注也有明显改善．表明ＩＳＤＮ能明显改善９９ｍＴｃ－ＭＩＢＩ对心肌存活的探测效果．     

~（99m）Tc－MIBI门控平面心肌显像评价心肌梗塞区存活心肌──与~（99m）Tc─MIBISPECT及~（18）F－FDGPET结果比较

为评价９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）平面门控心肌显像（ＥＧＰ）在心肌梗塞患者存活心肌判断中的准确性，对２１例心肌梗塞患者进行了静息ＥＧＰ、静息和运动９９ｍＴｃ－ＭＩＢＩ心肌单光子发射计算机断层（ＳＰＥＣＴ）显像及饥饿时静息１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电于发射计算机断层（ＰＥＴ）显像．在２１例患者共１０５个心肌节段中，有１５个节段运动ＳＰＥＣＴ半定量分析局部９９ｍＴｃ－ＭＩＢＩ放射性分布大于左室峰计数的８０％（即正常节段），从本研究中排除．其余９０个节段中有７７个节段ＰＥＴ显像ＦＤＧ摄取明显，１３个节段无ＦＤＧ摄取．以ＦＤＧＰＥＴ为标准，ＥＧＰ在存活心肌判断中的灵敏度和特异性分别为９６％和７７％，而静息ＳＰＥＣＴ的灵敏度及特异性分别为９６％及６９％．两种显像方法在存活心肌判断中差异无显著性，同时两者在心肌节段间计分比较中有良好的一致性（ｒ＝０．８６）．提示ＥＧＰ在存活心肌判断中与ＭＩＢＩＳＰＥＣＴ相似．     

Assessment of myocardial viability after myocardial infarction

Conclusions  The data presented above suggest that assessment of myocardial viability after MI, particularly in those patients with severe LV dysfunction, is important for the identification of those with the highest risk, in whom revascularization can be of clinical benefit. There is growing and consistent evidence that patients with relatively large areas of dysfunctional but viable myocardium after MI have improved function, symptoms, and survival with prompt revascularization compared with medical therapy alone. Most importantly, long-term survival with revascularization in these patients is comparable with that achieved with cardiac transplantation. There are several methods available to the clinician with which to investigate the presence of tissue viability, and the evidence suggests that the scintigraphic approaches are the most sensitive. These observations suggest that noninvasive investigation of the amount of ischemic myocardium should be an important component of the diagnostic evaluation of patients with severe LV dysfunction after MI. This approach will likely enhance the often difficult process of selecting patients with poor cardiac function in whom revascularization will likely improve both the quality and quantity of life.     

Nitrate-augmented myocardial imaging for assessment of myocardial viability

²⁰¹Tl myocardial perfusion imaging is presently done by several possible strategies. Stress/delayed redistribution, stress/redistribution/reinjection, and rest/redistribution imaging can be useful in the clinical assessment of myocardial viability. Unfortunately, the extent of myocardial viability may still be underestimated even by ²⁰¹Tl reinjection imaging, compared with ¹⁸F-fluorodeoxyglucose positron emission tomography. ^99mTc-labeled sestamibi imaging provides results similar to those of ²⁰¹Tl imaging in the detection of coronary artery disease, but several previous studies suggest that stress/rest ^99mTc-labeled sestamibi imaging significantly underestimates myocardial viability. Recently it has been reported that the administration of nitrates, before ²⁰¹Tl reinjection, improves detection of defect reversibility. Several studies also suggested that administration of nitrates before the injection of ^99mTc-labeled sestamibi significantly improved detection of reversibility with this agent, whereas additional studies showed further that this combination improves the predictive accuracy for recovery of left ventricular function and perfusion after coronary revascularization, compared with a standard rest ^99mTc-labeled sestamibi study. Nitrate administration before the injection of ²⁰¹Tl and ^99mTc-labeled sestamibi may thus be a potentially attractive alternative for the evaluation of myocardial viability. Although the available results are encouraging, further studies are needed to evaluate the clinical value of ²⁰¹Tl and ^99mTc-labeled sestamibi imaging, in combination with nitrates, for predicting recovery of left ventricular dysfunction.     

Assessment of regional myocardial function by ECG-gated myocardial SPECT]

PURPOSES: Regional myocardial functional parameters were assessed by ECG-gated myocardial SPECT analysis in normal subjects and ischemic heart diseases. METHODS: Normal subjects (13 male and 10 female) and 51 patients with chronic ischemic heart disease underwent ECG-gated myocardial SPECT. A dose of 740 MBq of 99mTc-MIBI was injected at rest, and gated SPECT was performed 60 min later. Wall motion (WM) and systolic wall thickening (WT), % tracer uptake were evaluated by quantitative gated SPECT program (QGS). Regional parameters were obtained in the 16 segments based on the functional polar map. In the normal group, standard values were evaluated in the lateral, septal, anterior and inferior regions both in male and female subjects. In the ischemic heart disease group, sensitivity and specificity of these parameters were assessed in each segment. To estimate the ability of WM and WT in detecting regional dysfunction, decreased perfusion area, which was defined as < mean - 2SD by the normal profile, was used as a standard. The receiver operating characteristics (ROC) area analysis was also performed. RESULT: In the normal profile, % tracer uptake was decreased in the anterior segments of female group, no significant difference was observed between male and female in WM and WT. WM was decreased in the septum and increased in the lateral segment. WT didn't show any difference regional difference. Sensitivity and specificity of WM were 56%/91% in the anterior, 0%/100% in the septum, 43%/87% in the inferior, 31%/85% in the lateral. WT were 67%/93% in the septum, 67%/79% in the inferior, and 59%/81% in the septum. The area under ROC curve was WM 0.63, WT 0.85 (p < 0.005 between WM and WT) in the septum, in inferior WM 0.77, WT 0.80 (p = 0.57), in anterior WM 0.86, WT 0.87 (p = 0.095), in lateral WM 0.68, WT 0.78 (p = 0.037). CONCLUSION: In normal profile, the % tracer uptake in the anterior wall decreased in females, but WM and WT did not show significant difference in each region affected this influence. The septal WM was decreased in the normal profile and ability to diagnose regional function was also decreased compared with WT. Thus, we can conclude that WT is preferable for detecting septal functional abnormality.     

Acute myocardial infarction during adenosine myocardial perfusion imaging

Journal of Nuclear Cardiology -     

大鼠心肌缺血再灌注损伤中的心肌细胞凋亡

 目的 观察MIRI时心肌细胞凋亡现象及其病理组织学改变,探讨细胞凋亡在MIRI中的意义.方法 采用SD大鼠MIRI模型,用原位末端标记染色检测心肌细胞凋亡和HE染色法检测心肌病理组织学改变.结果 假手术组及MIRI大鼠左室非缺血心肌组织中均末发现凋亡细胞出现,MIRI60 min、90 min和120 min大鼠缺血心肌中均可见凋亡细胞,且凋亡细胞的个数随再灌注时间的延长而增多,分别为36.3±8.76个/视野,38.41±14.21个/视野和48.01±23.87个/视野..结论 缺血后再灌注损伤可诱发心肌细胞凋亡.     

血浆心肌细胞损伤标志物检测急性心肌梗死患者心肌损伤的临床研究

目的 探讨血浆心肌细胞损伤标志物在检测急性心肌梗死（AMI）患者心肌损伤中的价值。 方法 采用放射免疫分析法测定184例AMI患者和60名健康体检者（正常对照组）血浆心肌肌钙蛋白I（CTnI）、TNF-α、高敏C反应蛋白（hs-CRP）和β₂微球蛋白（β₂-MG）水平,并进行比较性分析。同时测定它们诊断AMI的特异度、阳性、阴性预测值、准确率以及入院后3、6、9 h时的灵敏度。 结果 184例AMI患者血浆CTnI、TNF-α、hs-CRP和β₂-MG水平较正常对照组均显著升高（t_CTnI=6.384,P＜0.001;t_TNF-α=2.136,P＜0.05;t_hs-CRP=5.109,P＜0.001;t_β2-MG=3.185,P＜0.01）,以血浆CTnI和hs-CRP水平升高最为显著。血浆CTnI、TNF-α、hs-CRP和β₂-MG水平对AMI患者诊断的特异度分别为96.67%、51.67%、65.00%和48.33%。入院后3、6和9 h时对AMI患者诊断的灵敏度:血浆CTnI分别为21.74%、92.93%和98.37%;血浆TNF-α分别为17.93%、65.76%和69.02%;血浆hs-CRP分别为16.30%、78.26%和79.89%;血浆β₂-MG分别为21.20%、69.57%和74.46%;以血浆CTnI为最高。阳性、阴性预测值和有效率亦以血浆CTnI为最高,分别为89.67%、88.33%、89.24%。 结论 心肌细胞损伤标志物CTnI不仅是早期诊断AMI的有效指标,而且具有治疗随访的临床价值。     

民航飞行人员冠状动脉肌桥致急慢性心肌缺血二例

长期以来 ,冠心病或急性冠状动脉事件在民航飞行人员中时有发生 ,对飞行安全威胁极大 ,其病理基础均为冠状动脉粥样硬化所致[1,2 ] 。然而 ,近年发现两例民航飞行人员的急慢性心肌缺血 ,系由冠状动脉前降支 (leftanteriordescending ,LAD)肌桥引起 ,这在以往的飞行人员心血管疾病中尚未见报道 ,值得总结 ,现报道如下。　　一、临床资料例 1　男性 ,发病年龄 4 7岁 ,MD 11航空机械师 ,总飞行时间 15 36 6h。2 0 0 0年 8月驻外飞行期间 ,某日午餐后突发胸闷、胸骨后压榨性疼痛 ,伴大汗、焦虑等。急救中发现血压下降 ,心电图 :V1V4T波高尖 …     

Quantitative evaluation of myocardial viability using Tl-201 myocardial SPECT]

In order to evaluate myocardial viability, we developed a new method for quantification of redistributed area in Tl-201 myocardial SPECT, and it was applied to 71 patients with LAD lesion. Initial image was subtracted from delayed image, and redistributed area was displayed as an unfolded map (viability map). Extent and viability score, which correspond to extent and degree of the viable area, was also calculated. In the cases with prior myocardial infarction, viability score was widely distributed and extent score was smaller, while the cases with angina pectoris had larger extent score. Visual assessment of redistribution to the infarcted area was compared with % score, which was calculated as ratio to initial defect score. When the criteria of viability was defined as % viability score greater than 36 or % extent score greater than 16, quantitative evaluation agreed with visual assessment, and corresponded to clinical course. This method was considered to be effective for evaluation of extent and degree of myocardial viability, but further evaluation need to be done in comparison with reinjection, PET study, and so on, and usefulness in multi-vessel disease.