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目的:应用核素心肌灌注显像,对糖尿病引起的冠状动脉粥样硬化斑块的不稳定性进行临床研究。方法:选择118例住院患者,其中糖尿病合并冠心病患者(糖尿病病史>5年)88例,单纯冠心病患者30例,冠状动脉造影检查血管均有不同程度轻、中度狭窄(50%~75%)。对其分别进行核素心肌灌注显像,并于1.5~2年后对所有患者进行核素心肌灌注显像随访评估,对其中严重缺血和心肌梗死患者同时进行冠状动脉造影检查。结果:糖尿病组随访前核素心肌灌注显像轻度缺血45例,中度缺血36例,阴性7例,随访后核素心肌灌注显像轻度缺血32例,中度缺血44例,严重缺血及心肌梗死10例(血管狭窄>90%),2例死亡;单纯冠心病组随访前核素心肌灌注显像轻度缺血20例,中度缺血8例,阴性2例,随访后核素心肌灌注显像轻度缺血18例,中度缺血11例,严重缺血及心肌梗死1例(血管狭窄>90%),死亡0例。2组间随访后较随访前缺血面积、严重程度、射血分数值变化差异均有统计学意义(t=5.61,4.38,2.58;P均<0.05)。结论:核素心肌灌注显像对诊断及监测、评估糖尿病合并冠心病斑块的不稳定性有其重要临床意义。
Objective: To study the instability of diabetic atherosclerotic plaque by radionuclide myocardial perfusion imaging. Methods: A total of 118 inpatients were selected, including 88 patients with diabetes mellitus (coronary heart disease> 5 years), 30 patients with simple coronary heart disease (CHD), and coronary artery angiography with mild to moderate stenosis (50% -75% %). Each of them was subjected to radionuclide myocardial perfusion imaging. All patients were evaluated by radionuclide myocardial perfusion imaging 1.5 to 2 years later, and coronary angiography was performed in patients with severe ischemia and myocardial infarction. Results: Pre-nuclide myocardial perfusion imaging in diabetic group was mild ischemia in 45 cases, moderate ischemia in 36 cases and negative in 7 cases. After myocardial infarction, myocardial ischemia in 32 cases, moderate ischemia 44 Cases of severe ischemia and myocardial infarction in 10 cases (stenosis> 90%), 2 patients died; coronary heart disease group before myocardial perfusion imaging mild ischemia in 20 cases, moderate ischemia in 8 cases, negative 2 For example, 18 cases of mild ischemia, 11 cases of moderate ischemia, 1 case of severe ischemia and myocardial infarction (vascular stenosis> 90%) and 0 died were followed up. There were significant differences in ischemic area, severity and ejection fraction before follow-up after follow-up between two groups (t = 5.61,4.38,2.58; P <0.05). Conclusion: The myocardial perfusion imaging of radionuclides has important clinical significance for the diagnosis and monitoring of unstable plaque in diabetic patients with coronary heart disease.