摘要目的:探讨 99Tc m-焦膦酸盐(PYP)SPECT显像鉴别诊断转甲状腺素蛋白型心脏淀粉样变(ATTR-CA)与肥厚型心肌病(HCM)的效能。 方法:回顾性分析2020年6月至2023年3月于中南大学湘雅二医院经心外活组织检查和心脏超声明确诊断为ATTR-CA[35例(男28例，女7例)；年龄62.5(58.6，64.3)岁]或HCM[14例(男13例，女1例)；年龄60.5(57.3，68.7)岁]的患者资料。所有患者在注射370～720 MBq 99Tc m-PYP后1 h行平面显像和SPECT断层显像；对显像图进行视觉评分(0～1分为阴性，2～3分为阳性)，计算心脏与对侧肺摄取比值(H/CL)；采用 χ2检验比较ATTR-CA和HCM组间视觉评分差异，计算视觉评分法的诊断效能；行Mann-Whitney U检验比较组间H/CL差异；采用ROC曲线分析H/CL鉴别诊断ATTR-CA和HCM的效能。 结果:ATTR-CA组34例视觉评分≥2分，1例视觉评分<2分；HCM组6例视觉评分为2分，8例视觉评分<2分；视觉评分诊断ATTR-CA的灵敏度为97.1%(34/35)，特异性为8/14；ATTR-CA与HCM组间视觉评分差异有统计学意义( χ2＝16.20， P<0.001)。ATTR-CA组H/CL明显高于HCM组[2.08(1.97，2.20)与1.26(1.17，1.35)； z＝-5.09， P<0.001]；ROC曲线分析示H/CL最佳截断值为1.45[AUC：0.980(95% CI：0.946～1.000)， P<0.001]，H/CL鉴别诊断HCM和ATTR-CA的灵敏度为97.1%(34/35)，特异性为14/14。 结论:99Tc m-PYP SPECT显像有助于鉴别诊断ATTR-CA和HCM，H/CL鉴别诊断这2种疾病的最佳截断值为1.45。

abstractsObjective:To investigate the efficacy of 99Tc m-pyrophosphate (PYP) SPECT imaging for the differential diagnosis of transthyretin-related cardiac amyloidosis (ATTR-CA) and hypertrophic cardiomyopathy (HCM). Methods:Data of patients who were definitively diagnosed with ATTR-CA (35 patients (28 males, 7 females); age 62.5(58.6, 64.3) years) or HCM (14 patients (13 males, 1 female); age 60.5(57.3, 68.7) years) by extracardiac biopsy and echocardiography in the Second Xiangya Hospital of Central South University between June 2020 and March 2023 were retrospectively analyzed. All patients underwent planar and SPECT imaging 1 h after injection of 370-720 MBq 99Tc m-PYP. Visual scoring was performed (0-1 was negative, 2-3 was positive), and heart-to-contralateral lung uptake ratio (H/CL) was calculated based on planar images. The χ2 test was used to compare the difference in visual scores between ATTR-CA and HCM groups, and the diagnostic efficacy of the visual score was calculated. The H/CL differences between ATTR and HCM groups were compared with Mann-Whitney U test, and the ROC curve was used to analyze the efficacy of H/CL for the differential diagnosis of ATTR-CA and HCM. Results:There were 34 patients with visual scores≥2 and 1 patient with visual score<2 in the ATTR-CA group, 6 patients with visual scores =2 and 8 patients with visual scores <2 in HCM group, and there were significant differences between the 2 groups ( χ2=16.20, P<0.001). The diagnostic sensitivity of the visual score was 97.1%(34/35), and the specificity was 8/14. The H/CL in the ATTR-CA group was significantly higher than that in the HCM group (2.08(1.97, 2.20) vs 1.26 (1.17, 1.35), z=-5.09, P<0.001). The ROC curve analysis suggested that the optimal cut-off value was 1.45 (AUC: 0.980, 95% CI: 0.946-1.000; P<0.001); the sensitivity of H/CL differential diagnosis between HCM and ATTR-CA was 97.1%(34/35), and the specificity was 14/14. Conclusion:99Tc m-PYP SPECT imaging is useful in differentiation of ATTR-CA and HCM, and the optimal cut-off value of H/CL for differential diagnosis of these 2 diseases is 1.45.