目的研究(~(18)F-FDG)心肌代谢显像联合99锝m-甲氧异腈(~(99m)Tc-MIBI)心肌灌注显像的价值,通过双核素心肌显像诊断心梗患者心肌梗死区的坏死心肌或存活心肌,从而判定此项技术对心梗患者血运重建术(冠脉搭桥及冠脉支架术)的临床价值。方法126例经心脏冠脉造影证实的至少一支以上冠状动脉闭塞以及临床明确诊断为心肌梗塞的冠心病患者,在两日内分别行~(99m)Tc-MIBI心肌灌注显像及~(18)F-FDG心肌代谢显像,其图像分为显像剂分布减低、明显减低和缺损。其中,心肌灌注显像与心肌代谢显像不匹配为心肌存活,心肌灌注显像与心肌代谢显像匹配为心肌无存活。将纳入研究的心肌梗死患者分为3组:心肌存活组、部分心肌存活组和无心肌存活组。3组冠心病心梗患者在血运重建术前及术后均行心脏超声心动图检查并获得左室射血分数(LVEF)等心功能指标。结果 126例心肌梗死患者病例中剔除6例死亡患者,其中3例无心肌存活患者,2例部分心肌存活患者,1例有心肌存活患者。其余120例心梗患者均在血运重建术前及术后行超声心动图检查。其中,57例心肌存活组患者LVEF值(40.81±8.91)%,经过血运重建术后,LVEF值提高至(52.71±9.23)%,t=-5.23,心功能改善明显,统计学意义显著(P<0.05)。部分心肌存活组36例患者LVEF值(38.61±9.91)%经过血运重建术后提高至(44.71±9.73)%,t=-5.45,心功能改善尚可,有统计学意义(P<0.05)。无心肌存活组患者27例,LVEF值(35.11±7.91)%,经过血运重建术后LVEF值提高至(39.71±9.23)%,t=-5.89,心功能改善不佳,无统计学意义(P>0.05)。结论 ~(18)F-FDG心肌代谢显像联合~(99m)Tc-MIBI心肌灌注显像可以从心肌血流灌注和心肌葡萄糖代谢两个方面同时观察心肌状态,判断心肌梗死患者梗死区存在的坏死心肌或存活心肌,对冠心病心梗患者的血运重建术有重要的临床指导意义。 Objective To investigate the value of (~ (18) F-FDG myocardial perfusion imaging in 99m Tc m-methoxy isonitrile (~ (99m) Tc-MIBI) myocardial perfusion imaging Myocardial infarction area of ​​necrotic myocardium or viable myocardium, in order to determine the technology of myocardial infarction patients with revascularization (coronary artery bypass grafting and coronary stenting) clinical value. Methods Totally 99m Tc-MIBI myocardial perfusion imaging and ~ (18) angiography were performed in 126 patients with at least one coronary artery occlusion confirmed by cardiac coronary angiography and clinically diagnosed as myocardial infarction. F-FDG myocardial metabolic imaging, the image is divided into imaging agent distribution decreased significantly reduced and defects. Among them, myocardial perfusion imaging and myocardial metabolic imaging do not match myocardial survival, myocardial perfusion imaging and myocardial metabolic imaging match for the survival of the myocardium. The patients with MI included in the study were divided into 3 groups: myocardial survival group, partial myocardial survival group and no cardiac survival group. Cardiac echocardiography was performed before and after revascularization in 3 patients with coronary heart disease and cardiac function indexes such as left ventricular ejection fraction (LVEF). Results Six of 126 patients with myocardial infarction were excluded from the study. Among them, 3 patients had no cardiac survival, 2 patients had partial myocardial survival, and 1 patient had myocardial survival. The remaining 120 patients with myocardial infarction underwent echocardiography before and after revascularization. Among them, the LVEF value of 40 myocardial surviving patients was (40.81 ± 8.91)%. After revascularization, the LVEF increased to (52.71 ± 9.23)%, t = -5.23, and the cardiac function improved significantly with statistical significance P <0.05). The LVEF value of 36 patients with partial myocardial viability (38.61 ± 9.91)% improved to (44.71 ± 9.73)%, t = -5.45 after revascularization, with significant improvement in cardiac function (P <0.05) . There was no significant difference in cardiac function between the two groups (27 patients with no myocardial survival group, LVEF value (35.11 ± 7.91)%, LVEF increased to (39.71 ± 9.23)%, t = -5.89 after revascularization P> 0.05). Conclusions ~ (18) F-FDG myocardial perfusion imaging combined with ~ (99m) Tc-MIBI myocardial perfusion imaging can observe myocardial status simultaneously from myocardial perfusion and myocardial glucose metabolism to determine the presence of myocardial infarction Necrotic myocardium or viable myocardium, coronary heart disease in patients with myocardial reconstructive surgery has important clinical significance.