The developement of simple method for measuring coronary flow reserve and the clinically useful diagnosis of ischemia using NH_3 myocardial PET

从研究结果到目前为止，我们发现有高脂血症和糖尿病等动脉粥样硬化因素的患者，冠状动脉血流储备(CFR)往往在无明显冠状动脉狭窄的非病变区减少。我们测定了家族性高胆固醇血症(FH)患者的血流储备，因为双嘧达莫负荷下的血流储备测定可能与动脉粥样硬化的早期诊断有关。方法：对25例无心肌缺血病史的FH患者和14名对照组(9名男性和5名女性)进行研究。血清总胆固醇(毫摩尔/升)为5.33(SY.+-)。对照组为0.66，对照组为7.90(SY+-)。[]FH患者为0.77(p&lt；0.01)。结果：用正电子发射计算机断层扫描(PET)测量静息状态和潘生丁负荷时的心肌血流量(MBF)，并计算CFR。FH组安静时MBF(ml/min/100g体重心脏)(79.0±+-)。[)20.0)与对照组(70.0(]sy.+-)相当。[…更多)17.0)。然而，在双嘧达莫负荷期间，FH患者的MBF显著降低(163.0()sy.+.[]67.0.)高于对照组(286.0()sy.+-)。[)120.0，p&lt；FH患者CFR(2.09±+-.)[]0.62)也显著低于对照组(4.13(]sy.+-)。[)1.38，p&lt；0.01)。CFR显示FH患者的性别差异(1.85(]sy.+-.[]男性为0.40，男性为2.55()。女性为0.74(P&lt；0.05)，而对照组则不存在。CFR与血浆总胆固醇水平、脉搏血低密度脂蛋白、胆固醇水平呈显著负相关。结论：FH患者冠状动脉无症状的动脉粥样硬化可能降低了对潘生丁的扩张效应。结果表明，潘生丁负荷时冠状动脉血流储备的测定可能有助于冠状动脉粥样硬化的早期诊断和高脂血症药物治疗对动脉粥样硬化改善的评价。未来，对于糖尿病、肥胖、高血压、烟草等动脉粥样硬化的其他危险因素，我们将尝试评估该方法在冠状动脉粥样硬化的早期诊断和通过危险因素的药物治疗改善动脉粥样硬化方面的作用。较少

From research result until now, we experianced the coronary flow reserve (CFR) often reduce in non-diseased area without significant coronary stenosis in patients with atherosclerotic resk factors such as hyperlipidemia and dibetes mellitus. We measured flow reserve in patients with familial hypercholesterolemia (FH) because there maybe possibility that flow reserve measurement at dipyridamole stress is related to the early diagnosis of atherosclerosis.Methods : Twenty -five patients with FH (14 men, 11 women) without history of myocardial ischemia and 14 control subjects (9 men and 5 women) were studied. Total serum cholesterol (mmole/liter) was 5.33(]SY.+-。[)0.66 in control subjects and 7.90(]SY.+-。[)0.77 in FH patients (p<0.01). Results : Myocardial blood flow (MBF) at rest and during dipyridamole loading was measured using PET,and CFR was calculated. MBF (ml/min/100g weight heart) at rest in the FH group (79.0(]SY.+-。[)20.0) was comparable to that in control subjects (70.0(]SY.+-。[ … More )17.0). However, MBF during dipyridamole loading was significantly lower in FH patients (163.0(]SY.+-。[)67.0) than in control subjects (286.0(]SY.+-。[)120.0, p<0.01). CFR in FH patients (2.09(]SY.+-。[)0.62) was also significantly lower than in control subjects (4.13(]SY.+-。[)1.38, p<0.01). CFR showed a gender-specific variance in FH patients (1.85(]SY.+-。[)0.40 in men versus 2.55(]SY.+-。[)0.74 in women p<0.05) but not in control subjects. Significant inverse correlations between CFR and the total plasma chilesterol level as well as prasma LDL,cholesterol were observed. Conclusion : In FH,coronary arterial voasodilating effect to dipyridample may be reduced by asymptomatic atherosclerosis of coronary artery. We showed the possibility that the measurement of coronary flow reserve during dipyridamole loading maybe useful in early diagnosis of coronary arterial atherosclerosis and the evaluation of improvement of atheroscierosis by medical treatment of hyperlipidemia. In future, as to other risk factors of atheroscierosis such as diabetes mellitus, obesity hypertension and tobaco, we will try to evaluate whether this method is useful in early diagnosis of coronary arterial atherosclerosis and the evaluation of improvement of atherosclerosis by medical treatment of risk factors. Less