【摘要】 目的　探讨急性心肌梗死患者行经皮冠状动脉腔内成形术 (PTCA)和支架术后心肌血流、脂肪酸代谢及糖代谢的变化及其临床意义。方法　 2 2例急性心肌梗死患者 ,于发病后 4周行延迟PTCA ,术前 (急性期 )及术后 (慢性期 )分别行2 0 1 Tl、1 2 3I β 甲基碘苯脂十五烷酸 (BMIPP)SPECT显像及1 8F 脱氧葡萄糖 (FDG)PET心肌显像。将左心室分成 13个节段 ,采用 4级评分法对2 0 1 Tl、1 2 3I BMIPP显像放射性分布进行视觉评价 ,两者得分差为2 0 1 Tl BMIPP不匹配。在血流减低部位 ,定量测定1 8F FDG摄取。慢性期复查冠状动脉造影。结果　急性期心肌血流 脂肪酸代谢不匹配的节段 ,1 8F FDG摄取率明显高于匹配节段 [(76 .5± 10 .6 ) %和 (4 5 .8± 8.6 ) % ,P <0 .0 1],慢性期两者无明显差异。冠状动脉非再狭窄患者其慢性期2 0 1 Tl BMIPP不匹配 (0 .2 5± 0 .4 2 )及1 8F FDG摄取率 [(5 2 .1± 8.1) % ]较急性期 [0 .36± 0 .5 1和 (72 .8± 9.8) % ]明显降低 (P均 <0 .0 1) ;冠状动脉再狭窄患者其慢性期与急性期比较 ,2 0 1 Tl BMIPP不匹配及1 8F FDG摄取率无明显变化。结论　观察急性心肌梗死PTCA前后心肌血流 脂肪酸代谢及糖代谢的变化 ,可间接预测PTCA后再狭窄。更多还原

【Abstract】 Objective To investigate the changes of myocardial perfusion,fatty acid metabolism and glucose metabolism after percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI),and evaluate its clinical implication. Methods In 22 patients who underwent delayed PTCA after 4 weeks onset of AMI,dual SPECT with 201 Tl, 123 I-bata-methyl-iodophenyl pentadecanoic acid (BMIPP) and PET with 18 F-fluorodeoxglucose (FDG) were performed in acute phase (2 and 3 weeks) and chronic phase (5 months). Uptakes of 201 Tl and 123 I-BMIPP were evaluated by four defect score (DS),and the scores of two tracers were compared with each other in every segment. 201 Tl/BMIPP mismatch equal DS of BMIPP minus DS of 201 Tl. 18 F-FDG uptake were determined quantitatively in the segments with hypoperfusion. Results 18 F-FDG uptake of segments with myocardial perfusion-fatty acid metabolism mismatch was higher significantly than that of segments with perfusion-fatty acid metabolism match in the acute phase [(76.5±10.6)% &(45.8±8.6)%, P <0.01)],and no significant difference in the chronic phase. In patients without restenosis, 201 Tl/BMIPP mismatch (0.25±0.42) and 18 F-FDG uptake [(52.1±8.1) %]in chronic phase were obviously lower than that in the acute phase [0.36±0.51 & ( 72.8±9.8)%];in patients with restenosis,no significant difference between acute phase and chronic phase in 201 Tl/BMIPP mismatch and 18 F-FDG uptake. Conclusion Observation of the changes of myocardial perfusion-fatty acid metabolism and glucose metabolism have important value for the prediction of restenosis after PTCA in patients with AMI.更多还原