中文摘要：

目的通过回顾性分析，评价^99Tc^m-MIBI心肌灌注显像的有效性及安全性。方法选择来自6家医院共500例在1998年4月7日至2006年4月6日之间同时或者分别行^99Tc^mIBIMPI（包括静息显像和负荷显像）和CAG的患者。研究对象年龄33～88（60．1±11．1）岁，其中男335例，女165例。以CAG结果为“金标准”（1支血管狭窄≥50％为阳性），计算^99Tc^m-MIBIMPI的诊断效能。不同受累冠状动脉支数、狭窄程度及病变部位的^99Tc^mMIBIMPI结果采用X。检验进行对比。统计所有患者在显像中的不良反应发生情况。结果500例中运动负荷显像280例，药物负荷220例（腺苷负荷117例，ATP负荷71例，双嘧达莫负荷32例）；CAG阳性249例，阴性251例；累及LAD205例，RCA144例，LCX130例；单支病变101例，双支病变66例，三支病变82例。^99Tc^m-MIBIMPI诊断心肌缺血及心肌梗死的灵敏度为65．1％（162／249），特异性为81．3％（204／251），准确性为73．2％（366／500），阳性预测值为77．5％（162／209），阴性预测值为70．1％（204／291）。^99Tc^m-MIBIMPI对单支病变与双支病变的诊断灵敏度差异无统计学意义[52．5％（53／101）与65．2％（43／66），x^=2．624，P〉0．05]，而对三支病变的诊断灵敏度明显高于单支＋双支病变[80．5％（66／82）与57．5％（96／167）,X^2=12．801，P〈0．01]。狭窄率为50％～59％、60％～69％、70％～79％、80％～89％、90％～99％的各组间灵敏度差异无统计学意义，分别为38．8％（40／103）、39．6％（19／48）、43．4％（53／122）、51．2％（41／80）、52．7％（48／91）,X2=5．721，P〉0．05；狭窄率为100％时^99Tc^m-MIBIMPI的灵敏度[82．9％（29／35）]高于其他各组（x^2=18．362，P〈0．01）。^99Tc^m-MIBIMPI对LCX病变的诊断灵敏度低于LAD和RCA病变（x^2=7．619，P〈0．01），特异性和准确性三者差异无统计学意义（x^2=0?

英文摘要：

Objective To evaluate the diagnostic accuracy and safety of ^99Tcm-MIBI MPI by retro- spectively analyzing data from this multicenter study. Methods Participating centers included six hospi- tals： Peking University First Hospital, Beijing Fuwai Hospital of Chinese Academy of Medical Science and Peking Union Medical College, Anzhen Hospital of Capital Medical University, Beijing Hospital of Health Ministry, Beijing Tongren Hospital of Capital Medical University and Peking University People＇s Hospital. According to the inclusion and exclusion criteria, 500 subjects （335 male, 165 female, mean age （60.1 ± 11.1 ） years） who underwent MPI between April 1998 and April 2006 were enrolled. All subjects were investigated with stress/rest MPI and CAG within 1 month. Stress test was performed with bicycle ergometry or with intravenous dipyridamole, adenosine or ATP. Perfusion defects on MPI were allocated to corresponding coronary arteries. During the stress and imaging period, any discomfort or symptoms were recorded. Coro- nary stenosis with ≥ 50% luminal narrowing was considered significant in CAG and taken as the gold stand- ard. 99Tcm-MIBI MPI results for the number of stenosed vessels, stenotic severity and coronary artery alloca- tion were compared usingx2 test. Results There were 280 subjects that underwent exercise stress tests and the remaining 220 received pharmacological stress tests （117 adenosine, 32 dipyridamole, 71 ATP）. Two hundred and forty-nine patients had significant coronary stenosis and 251 had normal CAG. Out of the 249 patients with positive CAG results, 101 had one-vessel, 66 had two-vessel and 82 had three-vessel disease. Significant stenosis of the LAD was present in 205 patients, 144 had RCA stenosis and 130 had stenosis of the LCX. The sensitivity, specificity, accuracy, positive predictive and negative predictive values of MPI for detection of coronary artery disease were 65.1% （ 162/249）, 81.3% （204/251）, 73.2% （366/500）, 77.5% （162/209） and 70.1% （204/291