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| 題 名 | A Comparison of Dipyridamole Stress Lower-Limb Thallium-201 Scintigraphy with Ankle-Brachial Index in Assessing Peripheral Arterial Occlusive Disease of Diabetic Patients=Dipyridamole藥物壓力之鉈-201氯化亞鉈下肢掃描評估糖尿病人週邊動脈阻塞性疾病 |
|---|---|
| 作 者 | 張鈺弘; 陳春森; 廖國盟; 林明賢; | 書刊名 | 核子醫學雜誌 |
| 卷 期 | 19:4 民95.12 |
| 頁 次 | 頁225-230 |
| 分類號 | 415.21 |
| 關鍵詞 | 鉈-201下肢掃描; Dipyridamole藥物壓力; 糖尿病; 周邊動脈阻塞性疾病; Lower-limb thallium scintigraphy; Dipyridamole stress; Diabetic mellitus; Peripheral arterial occlusive disease; Ankle-brachial index; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:周邊動脈阻塞性疾病(PAOD)由於會造成糖尿病人很多併發症,已經是越來越重要的疾病指標。本研究以ankle-brachial pressure index (ABI)為標率,評估以dipyridamole藥物壓力鉈-201下肢掃描(LLTS)來建立更方便的PAOD指標的可行性。 方法:371位有其他心血管疾病危險因子(如高血壓、高血脂、年老、肥胖)之糖尿病患(203位男性及158位女性,包括了門診的病患以及因血糖控制不良而住院的病患,年齡62.6歲,標準差13.0歲)在完成鉈-201-氣化亞鉈心肌灌流掃描之後立刻進行下肢掃描。背面的下肢掃描結果取出臀部、大腿與小腿三段對稱範圍,以左右兩邊像素平均讀數比值小於0.9或大於1.1視為異常,並同時蒐集ABI等相關糖尿病指標進行比對。明顯的冠狀動脈疾病由兩名醫師判讀,其中234名病人並同時進行半定量summed stress score (SSS)當作另一參考,當SSS大於8即被視為有嚴重的冠狀動脈疾病。 結果:LTTS與ABI之間擁有統計學顯著的相關。以任何一段不對稱就視為異常的話,預測ABI可以達到63%靈敏度以及67%特異性,費歇氏檢定P值小於0.0001。而在LLTS與人工判讀的冠狀動脈疾病間,沒有發現相關性(P值等於0.8858)。以SSS大於8定義的冠狀動脈疾病與LLTS之間也沒有發現統計相關(P值等於0.6862)。 結論:Dipyridamole藥物壓力鉈-201下肢掃描合併心肌掃描是評估糖尿病人PAOD簡便而可行的方法,不過63%的靈敏度並不足以取代現有的工具如ABI成為常規臨床可用的篩檢方式。以鉈-201下肢掃描結果預測冠狀動脈疾病也是無定論的。 |
| 英文摘要 | Background: Peripheral arterial occlusive disease (PAOD) has become more important in the treatment of diabetic patients due to it accounts many morbidities and mortalities. This study investigates the feasibility of dipyridamole stress lower-limb thallium scintigraphy (LLTS) in assessing the peripheral arterial occlusive disease of DM patients by comparing with the results of ankle-brachial pressure index (ABI). Methods: A total of 371 diabetic patients (203 males, 158 females, mean age 62.6, SD 13.0) with one or more cardiovascular risk factor (hypertension, dyslipidemia, aging, obesity) were prospectively recruited. The criteria for inclusion were: (1) symptomatic PAOD or asymptomatic subjects in outpatient clinics; (2) Subjects with poor control of DM and hospitalization. All patients received dipyridamole stress LLTS started right after the myocardial perfusion SPECT image (MPI). The mean pixel counts of ROI of the three levels-posterior aspects of buttock, thigh and calf were calculated. The right-to-left ratio of mean pixel counts of three levels with value less than 0.9 or greater than 1.1 were defined as abnormal LLTS. The ABI data was collected for comparison. The result of angiographic significant coronary artery disease shown in MPI was interpreted by two nuclear physicians, and a semiquantitative MPI with summed stress score (SSS) was generated by QPS 3.0 (GE) software for reference in 234 patients. A SSS greater than 8 was considered to have positive CAD. Whether abnormal LLTS can predict CAD were analyzed. Results: The association of abnormal LLTS and abnormal ABI is statistically significant especially in the calf level. When asymmetric of any of the three levels is considered positive LLTS, it can predict the result of ABI with a sensitivity of 63% and a specificity of 67% by Fisher's exact test (P<0.0001). There was no statistically significant relationship between LLTS and visually interpreted CAD (P=0.8858) or between LLTS and positive CAD defined by SSS greater than 8 (P=0.6862). Conclusions: The dipyridamole stress LLTS coupled with myocardial perfusion scintigraphy is convenient and has the potential to access PAOD in DM patients. However, the sensitivity it provided (63%) was not sufficient to replace current available tools, such as ABI, for routine clinical screening use. Using LLTS as a predictor for CAD seems to be inconclusive. |
本系統中英文摘要資訊取自各篇刊載內容。