北京大学医学部机构知识库
Advanced  
IR@PKUHSC  > 北京大学第一临床医学院  > 核医学科  > 期刊论文
学科主题: 核医学
题名:
99Tcm-MIBI心肌灌注显像诊断效能与安全性评价的回顾性研究
其他题名: The diagnostic accuracy and safety of 99Tcm-MIBI myocardial perfusion imaging-a retrospective multicenter study
作者: 王荣福1; 邱艳丽1; 王立勤1; 张春丽1; 王蒨1; 姚稚明1; 田月琴1; 何作祥1; 戴皓洁1; 王茜1; 张建华1; 张旭初1; 米宏志1; 郭芳1; 焦建1; 于治国1; 陈雯1; 孙晓昕1; 李河北1; 岳明纲1; 任凌1
关键词: 心肌缺血 ; 心肌梗塞 ; 冠状动脉造影术 ; 体层摄影术,发射型计算机,单光子 ; MIBI ; Myocardial ischemia ; Myocardial infraction ; Coronary angiography ; Tomography,emission-computed,single-photon ; MIBI
刊名: 中华核医学与分子影像杂志
发表日期: 2012
DOI: 10.3760/cma.j.issn.2095-2848.2012.06.003
卷: 32, 期:6, 页:413-417
收录类别: 中国科技核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 通过回顾性分析,评价99Tcm-MIBI心肌灌注显像的有效性及安全性.方法 选择来自6家医院共500例在1998年4月7日至2006年4月6日之间同时或者分别行99Tcm-MIBI MPI(包括静息显像和负荷显像)和CAG的患者.研究对象年龄33~88(60.1±11.1)岁,其中男335例,女165例.以CAG结果为“金标准”(1支血管狭窄≥50%为阳性),计算99Tcm-MIBI MPI的诊断效能.不同受累冠状动脉支数、狭窄程度及病变部位的99Tcm-MIBI MPI结果采用x2检验进行对比.统计所有患者在显像中的不良反应发生情况.结果 500例中运动负荷显像280例,药物负荷220例(腺苷负荷117例,ATP负荷71例,双嘧达莫负荷32例);CAG阳性249例,阴性251例;累及LAD 205例,RCA 144例,LCX 130例;单支病变101例,双支病变66例,三支病变82例.99Tcm-MIBI MPI诊断心肌缺血及心肌梗死的灵敏度为65.1%(162/249),特异性为81.3% (204/251),准确性为73.2% (366/500),阳性预测值为77.5%(162/209),阴性预测值为70.1%(204/291).99Tcm-MIBI MPI对单支病变与双支病变的诊断灵敏度差异无统计学意义[52.5% (53/101)与65.2% (43/66),x2=2.624,P>0.05],而对三支病变的诊断灵敏度明显高于单支+双支病变[80.5% (66/82)与57.5% (96/167),x2=12.801,P<0.01].狭窄率为50% ~59%、60% ~ 69%、70% ~ 79%、80% ~89%、90% ~99%的各组间灵敏度差异无统计学意义,分别为38.8% (40/103)、39.6%(19/48)、43.4% (53/122)、51.2%(41/80)、52.7%(48/91),x2=5.721,P>0.05;狭窄率为100%时99Tcm-MIBI MPI的灵敏度[82.9%(29/35)]高于其他各组(x2=18.362,P<0.01).99Tcm-MIBI MPI对LCX病变的诊断灵敏度低于LAD和RCA病变(x2=7.619,P<0.01),特异性和准确性三者差异无统计学意义(x2=0.758和4.471,均P>0.05).显像过程中,共发生轻度不良反应21例,患者均自行缓解.结论 99 Tcm-MIBIMPI无创、安全、有效,可用于心肌缺血或心肌梗死患者治疗方案的决策、预后判断和动态监测. Objective To evaluate the diagnostic accuracy and safety of 99Tcm-MIBI MPI by retrospectively analyzing data from this multicenter study.Methods Participating centers included six hospitals:Peking University First Hospital,Beijing Fuwai Hospital of Chinese Academy of Medical Science and Peking Union Medical College,Anzhen Hospital of Capital Medical University,Beijing Hospital of Health Ministry,Beijing Tongren Hospital of Capital Medical University and Peking University People's Hospital.According to the inclusion and exclusion criteria,500 subjects (335 male,165 female,mean age (60.1 ±11.1) years) who underwent MPI between April 1998 and April 2006 were enrolled.All subjects were investigated with stress/rest MPI and CAG within 1 month.Stress test was performed with bicycle ergometry or with intravenous dipyridamole,adenosine or ATP.Perfusion defects on MPI were allocated to corresponding coronary arteries.During the stress and imaging period,any discomfort or symptoms were recorded.Coronary stenosis with ≥ 50% luminal narrowing was considered significant in CAG and taken as the gold standard.99Tcm-MIBI MPI results for the number of stenosed vessels,stenotic severity and coronary artery allocation were compared usingx2 test.Results There were 280 subjects that underwent exercise stress tests and the remaining 220 received pharmacological stress tests (117 adenosine,32 dipyridamole,71 ATP).Two hundred and forty-nine patients had significant coronary stenosis and 251 had normal CAG.Out of the 249 patients with positive CAG results,101 had one-vessel,66 had two-vessel and 82 had three-vessel disease.Significant stenosis of the LAD was present in 205 patients,144 had RCA stenosis and 130 had stenosis of the LCX.The sensitivity,specificity,accuracy,positive predictive and negative predictive values of MPI for detection of coronary artery disease were 65.1% (162/249),81.3% (204/251),73.2% (366/500),77.5% (162/209) and 70.1% (204/291),respectively.There was no significant difference in the detection sensitivity of MPI between one-vessel disease and two-vessel disease (52.5% (53/101) vs 65.2% (43/66),x2 =2.624,P > 0.05),while the sensitivity was significantly higher for three-vessel disease than that for one-vessel plus two-vessel disease (80.5% (66/82) vs 57.5% (96/167),x2 =12.801,P < 0.01).The sensitivities among coronary artery stenosis subgroups of 50%-59%,60%-69%,70%-79%,80%-89%,90%-99% were 38.8% (40/103),39.6% (19/48),43.4% (53/122),51.2% (41/80)and 52.7% (48/91),respectively and not significantly different (x2 =5.721,P > 0.05),while it was significantly higher in the subgroup with 100% stenosis (82.9% (29/35),x2 =18.362,P < 0.01).The sensitivity for LCX lesions was lower than that for LAD and RCA (x2 =7.619,P < 0.01),whereas the specificity and accuracy had no significant difference (x2 =0.758,4.471,both P > 0.05).Mild side-effects during the study were recorded in 21 patients and were relieved without medical treatment.Conclusion 99Tcm-MIBI MPI is accurate and safe for the detection of coronary artery disease.
语种: 中文
原文出处: 查看原文
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/43161
Appears in Collections:北京大学第一临床医学院_核医学科_期刊论文

Files in This Item:

There are no files associated with this item.


作者单位: 1.100034,北京大学第一医院核医学科
2.中国原子能科学研究院原子高科股份有限公司
3.首都医科大学北京安贞医院核医学科
4.卫生部北京医院核医学科
5.中国医学科学院、北京协和医学院阜外心血管病医院核医学科
6.首都医科大学北京同仁医院核医学科
7.北京大学人民医院核医学科
Service
Recommend this item
Sava as my favorate item
Show this item's statistics
Export Endnote File
Google Scholar
Similar articles in Google Scholar
[王荣福]'s Articles
[邱艳丽]'s Articles
[王立勤]'s Articles
CSDL cross search
Similar articles in CSDL Cross Search
[王荣福]‘s Articles
[邱艳丽]‘s Articles
[王立勤]‘s Articles
Related Copyright Policies
Null
Social Bookmarking
Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit

Items in IR are protected by copyright, with all rights reserved, unless otherwise indicated.

 

 

Valid XHTML 1.0!
Copyright © 2007-2017  北京大学医学部 - Feedback
Powered by CSpace