^99Tc^m心肌灌注显像和血浆同型半胱氨酸水平对判断川崎病心肌缺血的价值

目的：探讨^99Tc^m心肌灌注显像和血浆同型半胱氨酸（Homocysteine，Hcy）水平变化对判断川崎病患儿心肌缺血的应用价值。方法：59例确诊为川崎病的患儿根据病程分为急性发热期（2S例）、亚急性期（15例）和恢复期（19例）三组，15例因发热待查入院（后排除川崎病及其他心肌病变）的患儿作为对照组。所有病例均行^99Tc^m-MIBI负荷心肌灌注显像检查并采用微粒子酶联免疫分析法测血Hcy水平。结果：①心肌显像结果：59例川崎病患儿心肌灌注显像阳性31例，阳性率为52．5％，对照组心肌灌注显像未见异常。②血Hcy结果：59例川崎病患儿各期血Hcy水平明显高于对照组（P〈0．01）；31例心肌灌注显像阳性的川崎病患儿血Hcy水平明显高于心肌灌注显像阴性患儿（9．12±2．01）μmol／L比（6．08±1．89）μmol／L，P〈0．05]。结论：血Hcy水平升高可间接反映心肌缺血程度，与心肌灌注显像联合检测对判断川崎病引起的心肌缺血有较大的参考价值。

Value of the variation of homocysteine and 99Tcm nuclide myocardial perfusion imaging on judgement myocardial ischemia in patients with Kawasaki disease

Objective： To observe the diagnostic value about the variation of homocysteine （Hcy） and ^99Tc^m nuclide myocardial perfusion imaging on judgement myocardial ischemia in patients with Kawasaki disease （KD）. Methods： Fifty-nine children with final diagnosis for KD were studied and 15 children with fever but ruled out KD or other heart disease were regarded as control, The 59 patients were classified into 3 subgroups according to their clinical manifestations： acute phase （n=25）, sub-acute phase（n=15）, and chronic phase（n=19）. All subjects underwent ^99Tc^m-MIBI myocardial perfusion imaging and Hcy detection with microparticle enzyme immunoassay. Results：① The result of myocardial imaging： 31 of 59 （52.5%） patients with KD were positive in perfusion imaging, while it was negative in the control group.②The Hcy level of patients with KD was obviously higher than that of the control group（P〈0.01）; Compared with the patients whose myocardial parfusion imaging were negative,the Hcy level was obviously increased in those myocardial perfusion imagings were positive（9.12 ± 2.01） μmol/L VS （6.08± 1.89） μ mol/L, P〈0.05]. Conclusion： High Hcy level can indirectly predict myocardial ischemia degree, it is a useful method to combine with nuclide myocardial perfusion imaging for evaluating myocardial ischemia in KD.