标题：SPECT负荷心肌灌注显像在冠心病心肌缺血诊断及治疗指导中的应用

      作者：张院 1，任小慧 2，古超 3    1.西安市北方医院心内一科，陕西 西安 710043；2.陕西省第四人民医院老年病科，陕西 西安 710043；3.西安市北方医院放射科，陕西 西安 710043

      卷次： 2021年32卷20期

      【摘要】 目的 探究核医学单光子计算机断层扫描(SPECT)负荷心肌灌注显像在冠心病心肌缺血诊断与治疗中的指导效果。方法 回顾性分析2016年8月至2020年8月西安市北方医院收治的190例疑似为冠心病患者的相关影像学检查资料，所有患者均接受冠状动脉造影以及SPECT负荷心肌灌注显像检查，评估其在患者诊断及治疗中的价值。结果 接受SPECT负荷心肌灌注显像检查部分患者出现轻微不良反应，均在注射完成后120 s内消失；以冠脉造影检查作为金标准，SPECT负荷心肌灌注显像检查诊断冠心病的敏感度、特异度、准确度、阳性预测值与阴性预测值分别为97.14%、84.00%、93.68%、94.44%、91.30%；不同冠状动脉狭窄程度患者静息总积分比较差异无统计学意义(P>0.05)，而随着冠状动脉狭窄程度增加，患者负荷总积分与灌注积分差逐渐上升，差异有统计学意义(P<0.05)；Spearman相关性分析结果显示，冠状动脉狭窄程度与SPECT负荷心肌灌注显像指标静息总积分不相关(r=0.184，P>0.05)，与负荷总积分、灌注积分差正相关(r=0.673、0.702，P<0.05)；冠心病患者手术前后静息总积分比较差异无统计学意义(P>0.05)，而手术后负荷总积分与灌注积分差较手术前显著降低，差异有统计学意义(P<0.05)。结论 SPECT负荷心肌灌注显像用于诊断冠心病心肌缺血价值优异，可以有效评估患者冠状动脉狭窄程度。
      【关键词】 核医学单光子计算机断层扫描；负荷心肌灌注显像；冠心病；心肌缺血；冠状动脉狭窄；应用价值
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2021）20—2667—04

Application of stress myocardial perfusion imaging with SPECT in the diagnosis and treatment guidance ofmyocardial ischemia in coronary heart disease.
ZHANG Yuan 1, REN Xiao-hui 2，GU Chao 3, 1.Division 1 ofCardiovascular Medicine, Xi'an North Hospital, Xi'an 710043, Shaanxi, CHINA; 2. Department of Geriatrics, the FourthPeople's Hospital of Shaanxi, Xi'an 710043, Shaanxi, CHINA; 3. Department of Radiology, Xi'an North Hospital, Xi'an710043, Shaanxi, CHINA
【Abstract】 Objective To investigate the guiding effect of stress myocardial perfusion imaging with single-pho-ton emission computed tomography (SPECT) in the diagnosis and treatment of myocardial ischemia in coronary heartdisease. Methods The relevant imaging data of 190 patients with suspected coronary heart disease were retrospectivelyanalyzed, who were admitted to Xi'an North Hospital from August 2016 to August 2020. All patients received coronaryangiography and stress myocardial perfusion imaging with SPECT, and their value in the diagnosis and treatment wasevaluated. Results Some patients who underwent stress myocardial perfusion imaging with SPECT showed slight ad-verse reactions, which disappeared within 120 s after the injection. Taking coronary angiography as the golden standard,the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of stress myocardial perfu-sion imaging with SPECT in the diagnosis of coronary heart disease were 97.14% , 84.00% , 93.68% , 94.44% , and91.30%, respectively. No statistically significant differences were found in the total resting scores of patients with differ-ent degrees of coronary artery stenosis (P>0.05). As the degree of coronary artery stenosis increased, the total load scoreand the difference of perfusion score gradually increased (P<0.05). Spearman correlation analysis results showed thatthere was no correlation between the degree of coronary artery stenosis and the total resting score of stress myocardialperfusion imaging with SPECT (r=0.184, P>0.05), but the degree of coronary artery stenosis was positively correlatedwith the total load score and the difference of perfusion score (r=0.673, 0.702, P<0.05). No statistically significant differ-ences were found in the total resting scores of patients with coronary heart disease before and after operation (P>0.05).After operation, the total load score and the difference of perfusion score were significantly lower than those before theoperation (P<0.05). Conclusion Stress myocardial perfusion imaging with SPECT has excellent value in the diagnosisof myocardial ischemia in coronary heart disease, which can effectively evaluate the degree of coronary artery stenosis.
      【Key words】 Single-photon emission computed tomography; Stress myocardial perfusion imaging; Coronaryheart disease; Myocardial ischemia; Coronary artery stenosis; Application value