摘要目的 评价ATP介入MPI (ATP-MPI)对冠心病的诊断价值.方法 共纳入2012年7月至2013年10月5家医院214例[男156例,女58例,年龄10～83(60.96±11.60)岁]临床拟行MPI并在1个月内完成ATP-MPI和CAG病例.ATP介入试验:以0.16 rng·kg-1·min-1静脉注射ATP5 min,在第3分钟末注射99Tcm-MIBI 925 MBq,ATP注射完毕后观察1 min,无异常后终止试验.lh后行ATP-MPI,次日行静息MPI.显像表现为可逆性放射性减低或缺损者为心肌缺血,固定性缺损为心肌梗死.以CAG为“金标准”,计算ATP-MPI的诊断效能.结果 214例患者中冠状动脉正常94例(43.9％)、单支血管病变47例(22.0％)、双支血管病变22例(10.3％)、三支血管病变51例(23.8％),包括左主干病变4例.ATP-MPI正常106例(49.5％),异常108例(50.5％),其中可逆性放射性缺损65例(60.2％)、固定性放射性缺损15例(13.9％)、混合性放射性缺损28例(25.9％).ATP-MPI异常节段数平均为(4.2±2.4)个.ATP-MPI诊断冠心病的准确性为84.1％ (180/214),灵敏度为80.8％(97/120),特异性为88.3％(83/94),阳性预测值为89.8％(97/108),阴性预测值为78.3％ (83/106).结论 ATP-MPI诊断冠心病的效能较高,有较好的临床推广应用价值.

abstractsObjective To assess the value of ATP stress MPI (ATP-MPI) in the detection of coronary artery disease (CAD).Methods A total of 214 patients (156 males,58 females,age:10-83(60.96±11.60) years) of 5 hospitals from July 2012 to October 2013 were recruited.They all underwent ATPMPI and CAG within 1 month.ATP was infused intravenously at a speed of 0.16 mg · kg-1 · min-1 for 5 min.Adose of 925 MBq 99Tcm-MIBI was injected intravenously after 3 min of ATP infusion,and patients were monitored for 1 more minute after completion of ATP infusion.ATP-MPI was performed 1 h later and rest MPI was performed on the next day.Reversible perfusion defects were diagnosed as myocardial ischemia and fixed defects as myocardial infarct.The diagnostic efficiency was evaluated with CAG as the gold standard.Results Of the 214 patients,94 patients (43.9％) had negative findings; 47 patients(22.0％) had one vessel disease; 22 patients (10.3％) had two vessel disease and 51 patients(23.8％) had three vessel disease,including 4 with left main coronary artery disease.There were 106 patients (49.5％) with normal ATP-MPI and 108 patients(50.5％) with abnormal ATP-MPI,the latter of which consisted of 65 (60.2％)with reversible defects,15(13.9％) with fixed defects and 28(25.9％) with mixed defects.The mean abnormal segments detected by ATP-MPI were 4.2±2.4.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of ATP-MPI for the detection of CAD were 84.1％ (180/214),80.8％ (97/120),88.3％ (83/94),89.8％ (97/108) and 78.3％ (83/106),respectively.Conclusion ATP-MPI has high diagnostic efficacy in the detection of CAD,therefore,has potential value to promote for its clinical use.