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

从研究结果至今，我们发现在有高脂血症、糖尿病等动脉粥样硬化危险因素的患者，在无明显冠状动脉狭窄的非病变区，冠状动脉血流储备（CFR）往往降低。我们测量家族性高胆固醇血症（FH）患者的血流量储备，因为双嘧达莫应激下的血流量储备测量可能与动脉粥样硬化的早期诊断有关。方法：选取无心肌缺血史的FH患者25例（男14例，女11例）和对照组14例（男9例，女5例）。对照组血清总胆固醇（mmol /l）为5.33(]SY.+- [)0.66， FH组为7.90(]SY.+- [)0.77 （p<0.01）。结果：采用PET法测定静息及双嘧达莫负荷心肌血流量（MBF），计算CFR。FH组静息时MBF （ml/min/100g重量心脏）为79.0(]SY.+- .[)20.0，与对照组(70.0（]SY.+- .）相当。[…更多][…]然而，在双嘧达莫负荷期间，FH患者的MBF （163.0(]SY.+- .[)67.0）明显低于对照组（286.0(]SY.+- . [)120.0, p<0.01）。FH患者CFR （2.09(]SY.+- .[)0.62）也显著低于对照组（4.13(]SY.+- . [)1.38, p<0.01）。CFR在FH患者中显示出性别差异(男性为1.85(]SY.+-[)0.40，女性为2.55(]SY.+- [)0.74, p<0.05)，但在对照组中无差异。CFR与血浆总胆固醇水平、血浆低密度脂蛋白、胆固醇呈显著负相关。结论：无症状的冠状动脉粥样硬化可能会降低冠状动脉对双联丹的舒张作用。本研究表明，双嘧达莫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，对于动脉粥样硬化的其他危险因素，如糖尿病、肥胖、高血压、吸烟等，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评估药物治疗对动脉粥样硬化的改善作用。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