核素心肌灌注显像在扩张型心肌病 治疗中的价值研究

The efficacy and significance of nudein myocardial perfusion imaging in the treatment of patients with dilated cardiomyopathy

摘要:

目的 探讨核素心肌灌注显像（NMPI）对扩张型心肌病（DCM）患者住院治疗期间治疗指导 的有效性和意义。方法 选取2019 年1 月—2020 年1 月宜宾市第二人民医院收治的DCM 患者60 例作为 DCM 组，另取该院健康体检者30 例作为对照组。两组同期行NMPI 和核素心室造影显像（GBPI），DCM 组 治疗后行心功能核素显像复查。对比分析NMPI、GBPI 图像特征，比较DCM 患者治疗前后心功能参数变 化。结果 对照组NMPI 图像特征表现为左室大小正常，左室壁心肌显影清晰，且各节段放射性分布基本均 匀；GBPI 图像特征表现为位相图、直方图及室壁运动均未见异常，左室舒缩功能参数处于正常范围。DCM 组NMPI 图像特征表现为左室增大，左室心腔明显扩大，室壁明显变薄，负荷状态下各壁放射性分布弥漫性 减低，可见放射性分布呈花斑样改变，静息状态下放射性分布有所改善；GBPI 图像特征表现为左室增大，左 室收缩，相位分布不均，相角程>60 °，舒张运动明显减弱，心功能参数低于对照组（P <0.05）。60 例DCM 患者中，NMPI 异常包括节段性灌注完全缺损5 例（8.33%），不均匀减低7 例（11.67%），均匀减低34 例（56.67%）， 花斑样改变14 例（23.33%）。经治疗后，DCM 患者射血分数（EF）、高峰射血率（PER）和高峰充盈率（PFR） 较治疗前有不同程度改善（P <0.05）。结论 NMPI 技术是DCM 临床诊断、疗效评价的一种可靠方法，关注 核素在心肌中的分布特征，对DCM 患者的治疗具有重要指导意义。

Abstract:

Objective To investigate the efficacy and significance of nudein myocardial perfusion imaging (NMPI) in guiding the treatment of patients with dilated cardiomyopathy (DCM) during hospitalization. Methods A total of 60 patients with DCM admitted to our hospital from January 2019 to January 2020 were selected as the study subjects. Another 30 healthy volunteers were enrolled as the normal control group. Gated blood pool imaging (GBPI) was performed in the two groups at the same time, and cardiac functional nuclide imaging was performed in the DCM group after treatment to compare and analyze the imaging characteristics of NMPI and GBPI, and to compare the changes of cardiac functional parameters in DCM patients before and after treatment. Results In normal control group, NMPI images were characterized by normal left ventricular size, clear images of left ventricular wall, and basically uniform distribution of radioactivity in each segment. The GBPI images showed normal phase map, histogram and ventricular wall motion, and that the parameters of left ventricular systolic function were in the normal range. In the DCM group, NMPI images were characterized by enlargement of the left ventricle, significant expansion of the left ventricular cavity, and significant thinning of the left ventricular wall. Besides, NMPI images showed the diffuse reduction of the radioactive distribution in each wall and presented a patchy pattern in stress imaging, which was improved in the rest imaging. The GBPI images exhibited left ventricular enlargement, left ventricular contraction, uneven phase distribution, phase angle > 60°, significantly decreased diastolic motion, and significantly lower functional parameters than those of the normal control group (P < 0.05). Among the 60 patients with DCM, NMPI abnormalities included 5 cases (8.33%) of segmental complete perfusion defect, 7 cases (11.67%) of non-uniform reduction, 34 cases (56.67%) of uniform reduction, and 14 cases (23.33%) of patchy changes. After treatment, ejection fraction (EF), peak ejection rate (PER) and peak filling rate (PFR) in DCM group were improved to different degrees compared with those before treatment, and the differences were statistically significant (P < 0.05). Conclusions The NMPI technique is a reliable method for clinical diagnosis and evaluation of therapeutic efficacy of DCM. Furthermore, the characteristics of nuclide distribution in myocardium are of important guiding significance for the treatment of patients with DCM.