Wright D J, Williams S G, Lindsay H S, Sheard K L, Thorley P J, Sivananthan U M
The Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, UK.
Nucl Med Commun. 2001 Dec;22(12):1305-11. doi: 10.1097/00006231-200112000-00005.
We evaluated the use of adenosine, dobutamine and arbutamine with (99m)Tc-tetrofosmin myocardial perfusion imaging. Forty patients under investigation for suspected coronary artery disease were recruited. Each had a resting scan and two separate stress scans on different days, in a randomized cross-over study. Resultant images were blindly reported in 13 segments per scan as normal, reversible or fixed defects. A score was given (0-3) for segmental defect severity. Haemodynamic responses were as expected for each agent. Subjective side effect scores did not differ overall between agents. Adenosine caused a significantly higher incidence of abnormal taste (54%) than dobutamine and arbutamine (both 23%) and a lower incidence of palpitations (25% vs 69% and 54%, respectively), all P<0.05. Arbutamine caused significantly more chest pain than adenosine (77% vs 46%) though less flushing (35% vs 68%), both P<0.05. Comparison of the results obtained showed highly significant levels of segmental agreement for visual and semi-quantitative analysis between adenosine and arbutamine, kappa value and correlation coefficient of 0.78 and 0.86, respectively, dobutamine and adenosine 0.69 and 0.78, and arbutamine and dobutamine 0.75 and 0.78, all P<0.0001. Adenosine, arbutamine and dobutamine differ in their haemodynamic response and side effect profile but provide highly comparable results during (99m)Tc SPECT imaging.
我们评估了腺苷、多巴酚丁胺和阿拉布胺在锝-99m-替曲膦心肌灌注显像中的应用。招募了40名因疑似冠状动脉疾病而接受检查的患者。在一项随机交叉研究中，每位患者均进行了静息扫描，并在不同日期进行了两次单独的负荷扫描。每次扫描的所得图像按13个节段被盲法报告为正常、可逆或固定性缺损。根据节段性缺损严重程度给出评分（0 - 3分）。每种药物的血流动力学反应均符合预期。各药物之间总体主观副作用评分无差异。腺苷导致味觉异常的发生率显著高于多巴酚丁胺和阿拉布胺（分别为54% vs 23%和23%），心悸发生率较低（分别为25% vs 69%和54%），所有P<0.05。阿拉布胺导致的胸痛明显多于腺苷（77% vs 46%），但脸红较少（35% vs 68%），两者P<0.05。所得结果比较显示，腺苷与阿拉布胺之间在视觉和半定量分析方面节段性一致性水平非常显著，kappa值和相关系数分别为0.78和0.86，多巴酚丁胺与腺苷为0.69和0.78，阿拉布胺与多巴酚丁胺为0.75和0.78，所有P<0.0001。腺苷、阿拉布胺和多巴酚丁胺在血流动力学反应和副作用方面存在差异，但在锝-99m单光子发射计算机断层显像（SPECT）过程中提供了高度可比的结果。
