高血压患者99Tcm-MIBI负荷心肌灌注断层显像异常的临床意义
作者：杨永珍 李昭屏 刘轶敏 张卫方 张燕燕 张松林 王新 毛远
单位：杨永珍 张卫方 张燕燕 张松林 王新 毛远(北京医科大学第三医院核医学科 100083)；李昭屏(心内科)；刘轶敏(北京市邮电总医院核医学科)
关键词：高血压；体层摄影术,发射型计算机,单光子；MIBI
中华核医学杂志000405 【摘要】 目的 探讨心肌灌注显像异常对冠状动脉造影(CAG)正常的高血压患者的临床意义。方法 应用99Tcm-甲氧基异丁基异腈(MIBI)负荷与静息心肌灌注断层显像(MPT)定性方法,及侧壁/间隔计数比值(L/S)和负荷L/S与静息L/S之再比值,比较了21例CAG正常的高血压患者与11例血压正常的对照者的结果。结果 ①高血压组MPT阳性率为61.9%,显著高于对照组的9.1%,P<0.01,且以可逆性缺损为主,伴有少数反向填充;其心绞痛与心律失常发生率也明显高于对照组。②高血压组与对照组相比,负荷L/S与静息L/S之再比值明显降低,P<0.05。③高血压组MPT阳性患者负荷L/S与静息L/S之再比值低于MPT阴性患者,P<0.01;MPT阳性者烟酒嗜好明显多于MPT阴性者,分别为53.8%和12.5%,P<0.05。④MPT异常分布于各个节段,大多数无明显心肌肥厚表现。结论 ①心肌灌注显像异常可以发生在CAG正常、有或无心肌肥厚的高血压患者中。②长期烟酒嗜好是高血压患者出现心肌缺血的危险因素之一。
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The clinical significance of abnormal 99 Tcm-MIBI myocardial perfusion tomography in patients with hypertension
YANG Yongzhen LI Zhaoping LIU Yimin et al
(The Third Hospital of Beijing Medical University, Beijing 100083, China)
【Abstract】 Objective To evaluate the clinical significance of abnormal myocardial perfusion tomography in the hypertensive patients with normal coronary angiography. Methods Qualitative diagnosis,the average counts ratio of lateral to septal segments (L/S) and the ratio of stress L/S to rest L/S from stress and rest 99 Tcm-sestamibi myocardial perfusion tomography (MPT), and every clinical characteristic and the results from other examinations were compared between hypertensive patients (HP) and normotensive controls (NC). Every risk factor leading to coronary artery disease and related indexes in patients with positive MPT were compared with the results of patients with negative MPT. Results ①The positive rate of MPT in HP was obviously higher than that of NC,which was 61.9% vs 9.1%, respectively. Most focuses of MPT were reversible defects (RD), a few of them accompanied by reverse reversible defects (RRD). There were many more angina pectoris and heart arrhythmia attacks in HP than in NC. ②The ratio of stress L/S to rest L/S of HP was lower than that of NC (P<0.05). ③The ratio of stress L/S to rest L/S of the patients with positive MPT in HP significantly decreased compared with that of the patients with negative MPT (P<0.01). There were more patients being addicted to smoking and drinking in those with a positive than in those with a negative MPT (53.8% versus 12.5%, P<0.05). ④The abnormal defects of MPT in HP were almost seen in any segment of left ventricle and most of the patients had no left ventricular hypertrophy, but did smoke and drink. Conclusions ①Abnormal MPT exist in the HP with normal coronary angiography and not necessarily with left ventricular hypertrophy. ②The long-term addiction of smoking and drinking was one of the risk factors leading to arouse myocardial ischemia in HP.
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【Key words】 Hypertension; Tomography, emission-computed, single-photon; MIBI
对放射性核素心肌灌注断层显像诊断冠心病的特异性的评价有很大差异[1]。有文献报道,无冠状动脉梗阻的高血压患者可以出现心肌显像异常,但对其意义看法不同[2-6]。本研究采用99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注断层显像(MPT)定性与定量分析结合,比较了21例冠状动脉造影(CAG)正常的高血压患者与血压正常的对照者的结果,并同各种临床检查结果作了对比,现报道如下。
资料和方法
一、临床资料
1. 对照组11例,男7例,女4例,年龄37～65岁,平均(50.3±10.0)岁。临床无任何器质性疾病,血压正常,CAG正常。
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2. 原发性高血压患者21例,男13例,女8例,年龄30～71岁,平均(55.6±10.5)岁,均为我院住院患者。经生化、酶学、超声心动图等检查排除了糖尿病、风湿性心脏病、心肌炎、心肌病等疾患。经CAG检查全部除外冠心病(冠状动脉管腔狭窄<30%)。按WHO诊断标准进行分期,其中高血压I期10例,II期11例。
上述32例患者均有运动与静息对照,并进行超声心动图检查,测量舒张末期和收缩末期左室内径及舒张末期室间隔和左室后壁厚度,计算后壁/室间隔比值、左室质量指数(LVMI,g/m2)[5]和左心室射血分数(LVEF,%)。均作了99Tcm-MIBI MPT,与CAG检查间隔时间1～3周。其中运动负荷显像21例,多巴酚丁胺负荷试验显像11例。检查前皆停用扩张冠状动脉药物及β受体阻滞剂24 h。
二、检查方法
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1. 仪器与药品。仪器为Siemens Orbiter 7500型SPECT仪,低能高分辨平行孔准直器。99Tcm-MIBI由北京森科医药有限公司提供,标记率>97%。
2. 显像方法。负荷与静息MPT按常规进行,间隔1～2 d分别完成。采集矩阵64×64,放大倍数0.9,探头顺时针从右前斜45°至左后斜45°,连续32帧,15～20 s/帧。采用Butterworth滤波重建断层影像,层厚6.4 mm。以负荷、静息像对比的方式摄片。由2名以上医师共同阅片。病变类型分为:可逆性缺损区、固定性缺损区和反向填充。以每一轴向连续2层以上,2个轴向同时发现缺损区为异常。
3. 定量分析。用三层法定量分析[7,8]与侧壁/间隔计数比值法[3]设计定量方法。在短轴像上选择3个层面,①近心尖层面:选择刚出现心腔的层面之向后1个层面;②心底部层面:选择室间隔膜部放射性明显下降之前面第2个层面;③中间层面:即为心尖与心底之间正中的层面。用4像素×4像素的矩形ROI,分别定位于上述3层的间隔与侧壁中部,计算平均每个像素的计数及3层的均值。然后计算出运动与静息像的侧壁/间隔(L/S)比值,再计算运动L/S与静息L/S之再比值。
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结 果
1. 对照组与高血压组临床资料比较见表1。对照组未见心绞痛与心律失常,高血压组为10例,P=0.007。高血压组有2例间隔或后壁的厚度>12 mm,提示左室心肌肥厚。心肌质量指数两组间未见明显差异,但3例女性患者超过正常(>100 g/m2)。
2. 2组MPT定量分析结果。运动L/S对照组为1.12±0.11,高血压组为1.08±0.06;静息L/S对照组为1.10±0.09,高血压组为1.12±0.07。运动与静息L/S的再比值对照组为1.02±0.05,高血压组为0.97±0.05,t=2.58,P<0.05。
3. 高血压组MPT阳性与阴性患者临床症状与主要冠心病危险因素比较见表2。比较2组间发病时最高血压及高血压发病年限,收缩压分别为(186±27.6)和(181±19.6) mm Hg,舒张压分别为(102.7±7.3)和(113.1±16.7) mm Hg;高血压年限分别为(7.3±7.7)和(10.2±7.7) a,差异均无显著性。
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4. MPT异常在各型高血压的分布及异常类型。高血压Ⅰ期阳性率为50.0%(5/10),Ⅱ期为72.7%(8/11),差异无显著性。MPT阳性患者共波及34个节段,绝大部分患者同时累及2个以上节段,仅1例患者为1个节段受累。其中可逆性减低缺损区31个节段,占91.2%,反向填充3个节段,占9.8%,且反向填充节段皆伴有其他节段可逆性缺损。
讨 论
CAG基本正常的高血压患者出现心肌灌注显像异常的意义尚有争议。Houghton等[5]应用201Tl潘生丁+运动负荷心肌显像,及冠状动脉内多普勒超声测定血流储备的方法,研究了48例冠状动脉正常的高血压患者心肌显像异常与冠状动脉血流储备的关系,结果发现心肌灌注显像阳性患者血流储备功能明显低于心肌显像阴性者。Depuey等[3]发现,肾病晚期高血压患者常有侧壁201Tl摄取减低及L/S比值下降,而且这一变化同心肌是否肥厚无关。本研究结果与其相似,但心肌缺血的部位各壁都有。同对照组比较,L/S比值在负荷与静息像皆未见明显减低,但二者再比值明显降低,并同心肌灌注显像异常有关。推测该指标可能与高血压时微血管病变导致的心肌血流储备功能降低有关。高血压左心室肥厚患者可出现心肌灌注显像异常[2,5,9]。本组21例高血压患者中仅3例提示心肌肥厚,其余皆在正常范围,表明心肌显像异常也可发生在无心肌肥厚的高血压患者中,这可能与高血压患者冠状动脉小血管病变或狭窄、心肌纤维化伴血流动力学改变有关[4]。
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高血压患者心肌显像异常绝大部分表现为可逆性缺损,表明其存在冠状动脉血流储备功能下降,负荷状态下冠状动脉血流量不能充分增加,导致心肌缺血。本研究中有9.8%的异常节段表现为反向填充,且可逆性缺损区同时存在,这与X综合征患者反向填充率较高相似,可能与小血管病变或冠状动脉微循环调节异常有关,静息像上表现为不均匀低灌注,负荷状态下由于充血反应,可掩盖原低灌注状态[10]。长期烟酒嗜好可能是高血压患者出现心肌缺血的危险因素之一。
表1 对照组与高血压组临床资料比较 组别
例数
血压(mm Hg)
室间隔
(mm)
后壁
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(mm)
后壁/间壁
LVMI
(g/m2)
LVEF(%)
运动ECG
(+)
MPT
(+)
收缩压
舒张压
对照组
11
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125±11
79±6
9.1±1.4
8.4±1.2
0.94±0.19
76.8±17.7
70.0±7.2
2(18.2%)
1(9.1%)
高血压组
21
185±25*
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107±13△
9.9±2.0
9.5±1.6
0.97±0.17
95.6±25.5
68.4±7.6
8(38.1%)
13(61.9%)#
注:1 mm Hg=0.133 kPa。*t=7.60,P=0.01;△t=7.05,P=0.01;#t=2.85,P=0.007表2 MPT阳性与阴性患者各临床相关因素比较 相 关 因 素
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MPT阳性(13例)
MPT阴性(8例)
高脂血症
3(23.1%)
2(25.0%)
烟酒嗜好
7(53.8%)*
1(12.5%)
心绞痛或心律失常
7(53.8%)
3(37.5%)
运动静息L/S再比值
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0.94±0.05#
0.99±0.05
注:同MPT阴性比较,*P<0.05;#P<0.01 参 考 文 献
1，刘秀杰, 寇文, 姚康保, 等. 核素心肌灌注显像对冠心病诊断的特异性评价. 中华核医学杂志, 1992, 12:135-137.
2，Elhendy A, Geleijnse ML, Domburg RTV, et al. Comparison of dobutamine stress echocardiography and 99 Tcm-sestamibi single-photon emmission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Eur J Nucl Med, 1998, 25:69-78.
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3，Depuey EG, Guertler-Krawczynska E, Perkins JV, et al. Alterations in myocardial 201 Tl distribution in patients with chronic systemic hypertension undergoing single-photon emmision computed tomography. Am J Cardiol, 1988, 62:234-238.
4 何品玉, 董惟誉, 陈文新, 等. 高血压患者99Tcm-MIBI心肌灌注及硝酸甘油介入显像的初步探讨. 高血压杂志, 1997, 5:217-219.
5，Houghton JL, Frank MJ, Carr AA, et al. Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am Coll Cardiol, 1990, 15:43-51.
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6，李文华, 陈曼, 杨永珍, 等. 多巴酚丁胺负荷99Tcm-甲氧基异丁基异腈心肌灌注断层显像诊断冠心病的临床评价. 中国循环杂志, 1996, 11:140-143.
7，Gibbons RJ, Verani MS, Behrenbeck J, et al. Feasibility of tomographic 99 cm-hexakis-2-methoxy-2-methylpropyl-isonitrile imaging for the assessment of myocardial area at risk and the effect of treatment in acute myocardial infarction. Circulation, 1989, 80:1277-1286.
8，Christian TF, Behrenbeck T, Pellikka PA, et al. Mismatch of left ventricular function and infarct size demonstrated by 99 Tcm-isonitrile imaging after reperfusion therapy for acute myocardial infarction: identification of myocardial stunning and hyperkinesia. J Am Coll Cardiol, 1990, 16:1632-1638.
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9，Tuban JF, Szlachcic J, Hollenberg M, et al. Usefulness of 201 Tl scintigraphy in predicting the development of angina pectoris in hypertensive patients with left ventricular hypertrophy. Am J Cardiol, 1989, 64:45-49.
10，Fragasso G, Rossetti E, Dosio F, et al. High prevalence of the 201 Tl reverse redistribution phenomenon in patients with syndrome-X. Eur Heart J, 1996, 17:1482-1489.
(收稿日期:1999-09-12), 百拇医药
单位：杨永珍 张卫方 张燕燕 张松林 王新 毛远(北京医科大学第三医院核医学科 100083)；李昭屏(心内科)；刘轶敏(北京市邮电总医院核医学科)
关键词：高血压；体层摄影术,发射型计算机,单光子；MIBI
中华核医学杂志000405 【摘要】 目的 探讨心肌灌注显像异常对冠状动脉造影(CAG)正常的高血压患者的临床意义。方法 应用99Tcm-甲氧基异丁基异腈(MIBI)负荷与静息心肌灌注断层显像(MPT)定性方法,及侧壁/间隔计数比值(L/S)和负荷L/S与静息L/S之再比值,比较了21例CAG正常的高血压患者与11例血压正常的对照者的结果。结果 ①高血压组MPT阳性率为61.9%,显著高于对照组的9.1%,P<0.01,且以可逆性缺损为主,伴有少数反向填充;其心绞痛与心律失常发生率也明显高于对照组。②高血压组与对照组相比,负荷L/S与静息L/S之再比值明显降低,P<0.05。③高血压组MPT阳性患者负荷L/S与静息L/S之再比值低于MPT阴性患者,P<0.01;MPT阳性者烟酒嗜好明显多于MPT阴性者,分别为53.8%和12.5%,P<0.05。④MPT异常分布于各个节段,大多数无明显心肌肥厚表现。结论 ①心肌灌注显像异常可以发生在CAG正常、有或无心肌肥厚的高血压患者中。②长期烟酒嗜好是高血压患者出现心肌缺血的危险因素之一。
, 百拇医药
The clinical significance of abnormal 99 Tcm-MIBI myocardial perfusion tomography in patients with hypertension
YANG Yongzhen LI Zhaoping LIU Yimin et al
(The Third Hospital of Beijing Medical University, Beijing 100083, China)
【Abstract】 Objective To evaluate the clinical significance of abnormal myocardial perfusion tomography in the hypertensive patients with normal coronary angiography. Methods Qualitative diagnosis,the average counts ratio of lateral to septal segments (L/S) and the ratio of stress L/S to rest L/S from stress and rest 99 Tcm-sestamibi myocardial perfusion tomography (MPT), and every clinical characteristic and the results from other examinations were compared between hypertensive patients (HP) and normotensive controls (NC). Every risk factor leading to coronary artery disease and related indexes in patients with positive MPT were compared with the results of patients with negative MPT. Results ①The positive rate of MPT in HP was obviously higher than that of NC,which was 61.9% vs 9.1%, respectively. Most focuses of MPT were reversible defects (RD), a few of them accompanied by reverse reversible defects (RRD). There were many more angina pectoris and heart arrhythmia attacks in HP than in NC. ②The ratio of stress L/S to rest L/S of HP was lower than that of NC (P<0.05). ③The ratio of stress L/S to rest L/S of the patients with positive MPT in HP significantly decreased compared with that of the patients with negative MPT (P<0.01). There were more patients being addicted to smoking and drinking in those with a positive than in those with a negative MPT (53.8% versus 12.5%, P<0.05). ④The abnormal defects of MPT in HP were almost seen in any segment of left ventricle and most of the patients had no left ventricular hypertrophy, but did smoke and drink. Conclusions ①Abnormal MPT exist in the HP with normal coronary angiography and not necessarily with left ventricular hypertrophy. ②The long-term addiction of smoking and drinking was one of the risk factors leading to arouse myocardial ischemia in HP.
, 百拇医药
【Key words】 Hypertension; Tomography, emission-computed, single-photon; MIBI
对放射性核素心肌灌注断层显像诊断冠心病的特异性的评价有很大差异[1]。有文献报道,无冠状动脉梗阻的高血压患者可以出现心肌显像异常,但对其意义看法不同[2-6]。本研究采用99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注断层显像(MPT)定性与定量分析结合,比较了21例冠状动脉造影(CAG)正常的高血压患者与血压正常的对照者的结果,并同各种临床检查结果作了对比,现报道如下。
资料和方法
一、临床资料
1. 对照组11例,男7例,女4例,年龄37～65岁,平均(50.3±10.0)岁。临床无任何器质性疾病,血压正常,CAG正常。
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2. 原发性高血压患者21例,男13例,女8例,年龄30～71岁,平均(55.6±10.5)岁,均为我院住院患者。经生化、酶学、超声心动图等检查排除了糖尿病、风湿性心脏病、心肌炎、心肌病等疾患。经CAG检查全部除外冠心病(冠状动脉管腔狭窄<30%)。按WHO诊断标准进行分期,其中高血压I期10例,II期11例。
上述32例患者均有运动与静息对照,并进行超声心动图检查,测量舒张末期和收缩末期左室内径及舒张末期室间隔和左室后壁厚度,计算后壁/室间隔比值、左室质量指数(LVMI,g/m2)[5]和左心室射血分数(LVEF,%)。均作了99Tcm-MIBI MPT,与CAG检查间隔时间1～3周。其中运动负荷显像21例,多巴酚丁胺负荷试验显像11例。检查前皆停用扩张冠状动脉药物及β受体阻滞剂24 h。
二、检查方法
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1. 仪器与药品。仪器为Siemens Orbiter 7500型SPECT仪,低能高分辨平行孔准直器。99Tcm-MIBI由北京森科医药有限公司提供,标记率>97%。
2. 显像方法。负荷与静息MPT按常规进行,间隔1～2 d分别完成。采集矩阵64×64,放大倍数0.9,探头顺时针从右前斜45°至左后斜45°,连续32帧,15～20 s/帧。采用Butterworth滤波重建断层影像,层厚6.4 mm。以负荷、静息像对比的方式摄片。由2名以上医师共同阅片。病变类型分为:可逆性缺损区、固定性缺损区和反向填充。以每一轴向连续2层以上,2个轴向同时发现缺损区为异常。
3. 定量分析。用三层法定量分析[7,8]与侧壁/间隔计数比值法[3]设计定量方法。在短轴像上选择3个层面,①近心尖层面:选择刚出现心腔的层面之向后1个层面;②心底部层面:选择室间隔膜部放射性明显下降之前面第2个层面;③中间层面:即为心尖与心底之间正中的层面。用4像素×4像素的矩形ROI,分别定位于上述3层的间隔与侧壁中部,计算平均每个像素的计数及3层的均值。然后计算出运动与静息像的侧壁/间隔(L/S)比值,再计算运动L/S与静息L/S之再比值。
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结 果
1. 对照组与高血压组临床资料比较见表1。对照组未见心绞痛与心律失常,高血压组为10例,P=0.007。高血压组有2例间隔或后壁的厚度>12 mm,提示左室心肌肥厚。心肌质量指数两组间未见明显差异,但3例女性患者超过正常(>100 g/m2)。
2. 2组MPT定量分析结果。运动L/S对照组为1.12±0.11,高血压组为1.08±0.06;静息L/S对照组为1.10±0.09,高血压组为1.12±0.07。运动与静息L/S的再比值对照组为1.02±0.05,高血压组为0.97±0.05,t=2.58,P<0.05。
3. 高血压组MPT阳性与阴性患者临床症状与主要冠心病危险因素比较见表2。比较2组间发病时最高血压及高血压发病年限,收缩压分别为(186±27.6)和(181±19.6) mm Hg,舒张压分别为(102.7±7.3)和(113.1±16.7) mm Hg;高血压年限分别为(7.3±7.7)和(10.2±7.7) a,差异均无显著性。
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4. MPT异常在各型高血压的分布及异常类型。高血压Ⅰ期阳性率为50.0%(5/10),Ⅱ期为72.7%(8/11),差异无显著性。MPT阳性患者共波及34个节段,绝大部分患者同时累及2个以上节段,仅1例患者为1个节段受累。其中可逆性减低缺损区31个节段,占91.2%,反向填充3个节段,占9.8%,且反向填充节段皆伴有其他节段可逆性缺损。
讨 论
CAG基本正常的高血压患者出现心肌灌注显像异常的意义尚有争议。Houghton等[5]应用201Tl潘生丁+运动负荷心肌显像,及冠状动脉内多普勒超声测定血流储备的方法,研究了48例冠状动脉正常的高血压患者心肌显像异常与冠状动脉血流储备的关系,结果发现心肌灌注显像阳性患者血流储备功能明显低于心肌显像阴性者。Depuey等[3]发现,肾病晚期高血压患者常有侧壁201Tl摄取减低及L/S比值下降,而且这一变化同心肌是否肥厚无关。本研究结果与其相似,但心肌缺血的部位各壁都有。同对照组比较,L/S比值在负荷与静息像皆未见明显减低,但二者再比值明显降低,并同心肌灌注显像异常有关。推测该指标可能与高血压时微血管病变导致的心肌血流储备功能降低有关。高血压左心室肥厚患者可出现心肌灌注显像异常[2,5,9]。本组21例高血压患者中仅3例提示心肌肥厚,其余皆在正常范围,表明心肌显像异常也可发生在无心肌肥厚的高血压患者中,这可能与高血压患者冠状动脉小血管病变或狭窄、心肌纤维化伴血流动力学改变有关[4]。
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高血压患者心肌显像异常绝大部分表现为可逆性缺损,表明其存在冠状动脉血流储备功能下降,负荷状态下冠状动脉血流量不能充分增加,导致心肌缺血。本研究中有9.8%的异常节段表现为反向填充,且可逆性缺损区同时存在,这与X综合征患者反向填充率较高相似,可能与小血管病变或冠状动脉微循环调节异常有关,静息像上表现为不均匀低灌注,负荷状态下由于充血反应,可掩盖原低灌注状态[10]。长期烟酒嗜好可能是高血压患者出现心肌缺血的危险因素之一。
表1 对照组与高血压组临床资料比较 组别
例数
血压(mm Hg)
室间隔
(mm)
后壁
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(mm)
后壁/间壁
LVMI
(g/m2)
LVEF(%)
运动ECG
(+)
MPT
(+)
收缩压
舒张压
对照组
11
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125±11
79±6
9.1±1.4
8.4±1.2
0.94±0.19
76.8±17.7
70.0±7.2
2(18.2%)
1(9.1%)
高血压组
21
185±25*
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107±13△
9.9±2.0
9.5±1.6
0.97±0.17
95.6±25.5
68.4±7.6
8(38.1%)
13(61.9%)#
注:1 mm Hg=0.133 kPa。*t=7.60,P=0.01;△t=7.05,P=0.01;#t=2.85,P=0.007表2 MPT阳性与阴性患者各临床相关因素比较 相 关 因 素
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MPT阳性(13例)
MPT阴性(8例)
高脂血症
3(23.1%)
2(25.0%)
烟酒嗜好
7(53.8%)*
1(12.5%)
心绞痛或心律失常
7(53.8%)
3(37.5%)
运动静息L/S再比值
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0.94±0.05#
0.99±0.05
注:同MPT阴性比较,*P<0.05;#P<0.01 参 考 文 献
1，刘秀杰, 寇文, 姚康保, 等. 核素心肌灌注显像对冠心病诊断的特异性评价. 中华核医学杂志, 1992, 12:135-137.
2，Elhendy A, Geleijnse ML, Domburg RTV, et al. Comparison of dobutamine stress echocardiography and 99 Tcm-sestamibi single-photon emmission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Eur J Nucl Med, 1998, 25:69-78.
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3，Depuey EG, Guertler-Krawczynska E, Perkins JV, et al. Alterations in myocardial 201 Tl distribution in patients with chronic systemic hypertension undergoing single-photon emmision computed tomography. Am J Cardiol, 1988, 62:234-238.
4 何品玉, 董惟誉, 陈文新, 等. 高血压患者99Tcm-MIBI心肌灌注及硝酸甘油介入显像的初步探讨. 高血压杂志, 1997, 5:217-219.
5，Houghton JL, Frank MJ, Carr AA, et al. Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am Coll Cardiol, 1990, 15:43-51.
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6，李文华, 陈曼, 杨永珍, 等. 多巴酚丁胺负荷99Tcm-甲氧基异丁基异腈心肌灌注断层显像诊断冠心病的临床评价. 中国循环杂志, 1996, 11:140-143.
7，Gibbons RJ, Verani MS, Behrenbeck J, et al. Feasibility of tomographic 99 cm-hexakis-2-methoxy-2-methylpropyl-isonitrile imaging for the assessment of myocardial area at risk and the effect of treatment in acute myocardial infarction. Circulation, 1989, 80:1277-1286.
8，Christian TF, Behrenbeck T, Pellikka PA, et al. Mismatch of left ventricular function and infarct size demonstrated by 99 Tcm-isonitrile imaging after reperfusion therapy for acute myocardial infarction: identification of myocardial stunning and hyperkinesia. J Am Coll Cardiol, 1990, 16:1632-1638.
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9，Tuban JF, Szlachcic J, Hollenberg M, et al. Usefulness of 201 Tl scintigraphy in predicting the development of angina pectoris in hypertensive patients with left ventricular hypertrophy. Am J Cardiol, 1989, 64:45-49.
10，Fragasso G, Rossetti E, Dosio F, et al. High prevalence of the 201 Tl reverse redistribution phenomenon in patients with syndrome-X. Eur Heart J, 1996, 17:1482-1489.
(收稿日期:1999-09-12), 百拇医药