可视化发射CT评价针刺内关、心俞治疗冠心病心肌缺血的临床效应

目的应用针刺技术结合发射CT（single photon emission computed tomography，SPECT）可视化直观评价电针刺激下心肌血流灌注和功能恢复的效果及对冠心病治疗的临床效应。方法 59例已经确诊冠心病心绞痛患者随机分为两组，针刺心肌显像组（简称针刺组）32例，硝酸甘油心肌显像组（简称硝酸甘油组）27例。针刺组常规运动或药物负荷心肌显像后即刻取内关（双侧）、心俞（双侧）2穴位进行30 min电针针刺，针刺频率2/15 Hz，针刺电流强度9～18 mA，在针刺进行至15 min时注射99mTc-MIBI 370 MBq，针刺结束后即刻进行心肌断层显像；硝酸甘油组常规运动或药物高峰时静脉注射99mTc-MIBI 740 MBq 5 min后进行负荷心肌显像，负荷心肌显像完成后，瞩患者舌下含服硝酸甘油1 mg，5 min后静脉注射99mTc-MIBI 370 MBq，于5 min后显像。结果与治疗前比较，两组患者治疗后缺血心肌放射性摄取改变均有统计学意义（P<0.05， P<0.01）；针刺和含服硝酸甘油均可增加缺血心肌的血流灌注，但两者对缺血心肌的改善程度比较，差异无统计学意义（t=1.57，P>0.05）。结论应用发射CT技术可以清晰显示针刺对冠心病的治疗效果，为冠心病的疗效评价提供了一种新的可视化研究方法。

英文摘要:

Objective To evaluate the clinical efficacy of acupuncture combined single photon emission computed tomography （SPECT） in treating coronary heart disease （CHD） and its effect on the myocardial ischemia/perfusion and the recovery of heart functions. Methods Totally fifty-nine patients with confirmed CHD were randomly assigned to two groups， the acupuncture group （32 cases） and the nitroglycerine group （27 cases）. Patients in the acupuncture group were electro-acupunctured at bilateral Neiguan （PC6） and Xinshu （BL15） for 30 min with the frequency of 2/15 Hz and the current strength 9－18 mA after myocardial imaging induced by routine exercises or drug load. 99mTc-MIBI 370 MBq was injected 15 min after needling. The myocardial perfusion imaging was performed immediately after needling. 99mTc-MIBI 740 MBq was injected to those in the nitroglycerine group during routine exercises or drug load. The myocardial perfusion imaging was performed 5 min after injection. Patients were asked to sublingual administration of nitroglycerine 1 mg after the myocardial perfusion imaging was completed. 99mTc-MIBI 370 MBq was intravenously injected 5 min later， and myocardial perfusion imaging was performed 5 min after injection. Results There was statistical difference in changes of radioactive uptake between before and after treatment in the two groups （P<0.05， P<0.01）. Both acupuncture and buccal administration of nitroglycerine could increase the blood perfusion of ischemic myocardium. But there was no statistical difference in the improvement of ischemic myocardial cells （t=1.57， P>0.05）. Conclusion Using SPECT could clearly display therapeutic effects of acupuncture on CHD， thus providing a new visible research method for CHD studies.

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