放射性核素显像在心血管疾病方面的应用研究

发布时间：2018-03-05 05:01

  本文选题：左束支传导阻滞　切入点：冠心病　出处：《北京协和医学院》2014年博士论文　论文类型：学位论文

【摘要】：第一部分心肌代谢18F-FDG PET显像与心肌灌注99mTc-MIBI SPECT显像在评价冠心病合并左束支传导阻滞患者间隔灌注／代谢反向不匹配的研究 目的：左束支传导阻滞影响左心室的心肌灌注,而左束支传导阻滞对心肌代谢的影响尚未进行充分研究。因此本研究对冠心病合并左束支传导阻滞患者的心肌灌注和代谢显像进行研究。 方法：回顾性分析连续收集的65例疑诊或确诊冠心病合并左束支传导阻滞患者,所有患者均行心肌代谢18F-FDG显像和心肌灌注99mTc-MIBI显像。所有患者均进行冠状动脉造影和心脏超声检查。用左心室17节段划分法分别对相应节段的心肌灌注、心肌代谢,以及超声室壁运动进行评分。对所有患者以灌注正常、灌注减低、冠状动脉造影结果、冠状动脉供血区域以及灌注减低的不同程度分组评价心肌灌注和心肌代谢的关系,同时评价反向不匹配评分与心电图QRS间期的关系,以及反向不匹配评分与超声室壁运动评分的相关性。 结果：所有患者间隔的心肌灌注与心肌代谢的反向不匹配约占56.9%。在冠状动脉造影正常或没有前降支病变的患者,间隔的反向不匹配是100%。在冠状动脉造影前降支狭窄而前壁／间隔灌注正常的患者,间隔的反向不匹配是50%。在前降支狭窄而前壁／间隔灌注减低的患者,间隔的反向不匹配是54%。在心肌灌注正常的患者,间隔反向不匹配是82.8%,而在心肌灌注异常的患者间隔反向不匹配是36.1%。间隔反向不匹配比例在前降支供血区域高于回旋支和右冠状动脉供血区域。间隔的反向不匹配在轻到中度灌注缺损患者是60%,而在重度灌注异常到缺损患者是6.25%。间隔的反向不匹配评分与QRS间期负相关(r=-0.371,p=0.005),而其余室壁的反向不匹配评分与QRS间期相关性无统计学的意义。各室壁的反向不匹配评分与超声室壁运动评分相关性无统计学意义。 结论：在冠心病合并左束支传导阻滞的患者,间隔灌注／代谢反向不匹配是其主要的特征。间隔反向不匹配评分与心电图QRS间期呈负相关关系。 第二部分小型猪胸腔镜下微创植入新型Ameroid环致慢性心肌缺血模型的实验研究 目的：Ameroid缩窄环植入冠状动脉后完全闭塞时间短,不利于形成冬眠心肌,模型均一性差。为了克服上述技术问题,本实验提供了一种新型动脉缩窄环,其能够易于安放,且安放后对冠状动脉影响小,且便于术后随访和观察。为此,本实验评价新型Ameroid缩窄环建立小型猪慢性心肌缺血模型的有效性。 方法：18只中华小型猪(25±5Kg)分为2组,新型Ameroid缩窄环组(n=12)和对照组(n=6)。实验组通过微创胸腔镜下左冠状动脉回旋支植入新型Ameroid缩窄环,对照组采用相同的方法只游离不套环。实验组和对照组在术后4周行PET/CT及SPECT检测心肌葡萄糖代谢以及心肌血流灌注情况,冠状动脉造影检测回旋支狭窄情况,心脏超声在术前和术后4周检测心功能。 结果：心脏超声评价心功能变化,实验组术前左心室舒张末期容积是31.9±6.7ml,术后4周为42.8±15.5ml。术后4周与术前相比,左心室舒张末期容积显著增加(p0.05)。实验组术前左心室收缩末期容积是8.8±2.8ml,术后4周左心室收缩末期容积是13.7±9.3ml(p=ns)。实验组术前左心室每搏输出量是23.9±7.0ml,实验组术后4周左心室每搏输出量是29.0±8.2ml(p=ns)。实验组术前左心室射血分数为68.9±13.3%,术后4周左心室射血分数为69.8±9.0%(p=ns)。对照组术前左心室舒张末期容积是44.6±20.5ml,术后4周左心室舒张末期容积是36.3±6.5ml(p=ns)。对照组术前左心室收缩末期容积是10.2±1.9ml,术后4周左心室收缩末期容积是8.4±1.5ml(p=ns)。对照组左心室每搏输出量术前是23.7±7.8ml,术后4周左心室每搏输出量是27.9±5.6ml(p=ns)。左心室射血分数术前为69.0±5.8%,术后4周为76.7±3.9%(p=ns)。实验组术后4周冠状动脉造影显示,冠状动脉左回旋支狭窄程度为80±7.1%。术后4周心肌灌注显像和心肌代谢显像显示,实验组每只均有心肌存活,存活心肌的面积为9±4.8%。而对照组的心肌灌注显像和心肌代谢显像均正常。 结论：左冠状动脉回旋支植入新型Ameroid缩窄环,4周后心功能未见明显改变,外侧壁心肌血流灌注减低,而心肌代谢正常,表明心肌存活。推测新型Ameroid缩窄环可以成功建立慢性心肌缺血模型。
[Abstract]:The first part is myocardial metabolism 18F-FDG PET imaging and myocardial perfusion 99mTc-MIBI SPECT imaging in evaluating the interval perfusion / metabolic reverse mismatch between patients with coronary heart disease and left bundle branch block.
Objective: left bundle branch block affects left ventricular myocardial perfusion, while left bundle branch block has not yet fully studied the effect of left ventricular myocardial metabolism. Therefore, we studied myocardial perfusion and metabolic imaging in patients with coronary artery disease combined with left bundle branch block.
Methods: a retrospective analysis of 65 cases of suspected collected or confirmed coronary heart disease patients with left bundle branch block patients, all patients underwent 18F-FDG imaging of myocardial metabolism and myocardial perfusion 99mTc-MIBI imaging. All patients underwent coronary angiography and echocardiography. Left ventricular segment 17 division method of the corresponding segment of myocardial perfusion, myocardial metabolism, and ultrasonic wall motion score. All patients with normal perfusion, perfusion defect, coronary angiography results, evaluating the relationship between different degrees of myocardial perfusion and myocardial metabolism in coronary artery and regional perfusion reduced, at the same time the relationship between evaluation of reverse mismatch score and QRS interval of ECG, and reverse the matching score correlated with ultrasonic wall motion score.
Results: reverse myocardial perfusion and myocardial metabolism in all patients does not match the interval about 56.9%. patients without anterior descending coronary artery in normal or coronary angiography, interval reverse matching is 100%. in the anterior descending coronary artery angiography stenosis and wall / interval normal perfusion of patients, the reverse does not match the 50%. interval in the anterior descending artery wall / interval reduced perfusion of patients, the reverse does not match the 54%. interval in patients with normal myocardial perfusion, the interval does not match the reverse is 82.8%, and myocardial perfusion in patients with abnormal interval reverse mismatch is 36.1%. The reverse interval does not match the proportion in the anterior descending and circumflex blood supply area is higher than that of the right coronary artery. The interval of reverse mismatch in mild to moderate perfusion defect patients is 60%, while in the severe abnormal perfusion defect patients is to reverse 6.25%. interval does not match the score with QRS There was a negative correlation (r=-0.371, p=0.005), but there was no statistically significant correlation between the other side wall mismatch scores and QRS interval. There was no statistically significant correlation between the reverse mismatch scores and the wall motion score of each wall.
Conclusion: in patients with coronary artery disease complicated with left bundle branch block, interval perfusion / metabolic reverse mismatch is the main feature. There is a negative correlation between the interval reverse mismatch score and the QRS interval of ECG.
Experimental study on a new model of chronic myocardial ischemia induced by mini invasive implantation of a new type of Ameroid ring in second parts of miniature pigs
Objective: Ameroid constrictor implantation after coronary artery occlusion time is short, not conducive to the formation of hibernating myocardium, model uniformity. In order to overcome the technical problems, this experiment provides a new arterial constriction ring, which can be easily placed, and placed on the influence of coronary artery, and is convenient for postoperative follow-up and observation. Therefore, the evaluation of the new Ameroid shrink effective narrow ring to establish chronic myocardial ischemia model in pigs.
Methods: 18 pigs (25 + 5Kg) were divided into 2 groups, the new Ameroid constrictor group (n=12) and control group (n=6). The experimental group by Ameroid model of left circumflex coronary artery implantation of minimally invasive thoracoscopic constrictor and the control group by the same method. The experiment not only free ring group and control group at 4 weeks after operation of PET/CT and SPECT in detecting myocardial glucose metabolism and myocardial perfusion, coronary angiography detection of LCX stenosis, cardiac ultrasound in preoperative and postoperative 4 weeks to detect heart function.
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