摘要
目的观察根据心电图等临床疑诊为成人病毒性心肌炎心肌缺血型患者的双嘧达莫负荷心肌^201Tl SPECT显像的表现。方法选取根据排除法临床疑诊为病毒性心肌炎后遗症——心肌缺血型患者79例，年龄19～55岁。按体质量0．56mg／kg给予双嘧达莫，于4min内静脉注射，2min后注射^201Tl，注完后10及240min分别进行双嘧达莫负荷心肌^201Tl SPECT显像，原始图像经三维重建后由2位以上有经验的核医学科医师进行分析。不同性别组间显像结果比较行χ^2检验，经SAS8．1软件处理。结果在有ST—T改变的79例患者中，所有患者双嘧达莫负荷^201Tl图像（10min）均显示左心室心肌放射性分布正常，延迟（240min）显像时有34例（43．04％）患者（包括正常共272个节段）出现部分心肌节段反向放射性分布稀疏或缺损，即“反向再分布”，共累及36个节段：前壁9个（25．00％）、下壁11个（30．56％）、前间壁8个（22．22％）、前侧壁4个（11．11％）、心尖部4个（11．11％）；其中单个节段受累32例（94．12％），2个节段受累2例（5．88％）。79例中其余45例（56．96％）患者延迟显像则为放射性分布正常。有70．83％（17／24）的男性和30．91％（17／55）的女性患者延迟显像出现“反向再分布”，不同性别间差异有统计学意义（χ^2=10．86，P〈0．01）。结论双嘧达莫负荷心肌^201Tl SPECT显像对指导缺血型心肌炎诊治有益，另外对有ST-T改变的女性患者诊断需慎重考虑。
Objective The aim of this study was to explore the characteristics of dipyridamole ^201Tl SPECT myocardial perfusion imaging in patients clinically suspected of ischemic adult viral myocarditis （IAVM） based on electrocardiogram （ECG） changes. Methods Seventy-nine patients, age range 19-55, were studied in their post-IAVM sequelae period. All patients underwent pharmacologically stressed ^201Tl SPECT myocardial perfusion imaging after infusing 0.56 mg dipyridamole/kg intravenous in 4 min. The early and delayed SPECT images were acquired respectively at 10 min and 240 min after ^201Tl injection. Three-dimensional reconstructions of the original images were analyzed and reported by two or more experienced nuclear medicine physicians. The results of imaging between male and female genders were compared using χ^2-test with SAS 8.1 software. Results There were no abnormal myocardial perfusion findings in the early stress images in all patients. In the delayed study, however, 43.04% （34/79） of patients had abnormal results with reversed perfusion defects in 36 segments, including 9 segments （25.00%） in the anterior wall, 11 segments （ 30.56% ） in the inferior wall, 8 segments （ 22.22% ） in the antero-septal wall, 4 segments （11.11% ） in the antero-lateral wall, and 4 segments （11.11% ） in the apex. The perfusion defect of single segment was found in 32 patients. Reversed defects were identified in 70.83% （17/24） of male and 30. 91% （17/55） of female. There was a significant difference in proportion of abnormal findings between male and female genders （χ^2 = 10.86, P 〈 0.01 ）. Conclusions Dipyridamole ^201Tl SPECT myocardial perfusion imaging may have a value for diagnosis and treatment of the ischemic adult viral myocarditis. The ECG ST-T changes found in female may have higher false positive results and cautions should be taken.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2009年第6期373-375,共3页
Chinese Journal of Nuclear Medicine
基金
上海市自然科学基金（05ZR14106）
