熊去氧胆酸对 Tc-sestamibi 心肌灌注闪烁显像患者早期肝清除放射性示踪剂的影响：一项随机、双盲、安慰剂对照平行试验。

Effect of ursodeoxycholic acid in facilitating early hepatic clearance of radiotracer among patients undergoing Tc-sestamibi myocardial perfusion scintigraphy: A randomized double blind placebo controlled parallel trial.

机构信息

Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India.

Post Graduate Institute of Medical Education and Research (PGIMER), Gastroenterology, Chandigarh, India.

出版信息

J Nucl Cardiol. 2020 Dec;27(6):2337-2348. doi: 10.1007/s12350-019-01597-z. Epub 2019 Jan 29.

DOI:10.1007/s12350-019-01597-z

PMID:30697661

Abstract

BACKGROUND

Infra-cardiac tracer activity due to persistent hepatic activity interferes in inferior and infero-septal wall assessment during Tc-MIBI SPECT/CT myocardial perfusion scintigraphy (MPS) in evaluation of patients with coronary artery disease. It affects image interpretation with increased study duration. Ursodeoxycholic acid (UDCA) is known to enhance hepatic excretion of bilirubin and bile salts, though its role in enhancing the hepatic tracer clearance in facilitating cardiac imaging is not known.

METHODS

This prospective, randomized double-blind, placebo controlled clinical trial of 120 patients, referred for adenosine stress or viability MPS studies were randomized 1:1 to receive either UDCA or placebo. Outcome was quantitative & qualitative improvement in imaging for better interpretation and to reduce the waiting time for scan.

RESULTS

118 participants (59 ± 11.9 years; 84 men) underwent adenosine stress MPS or viability MPS. Sixty participants had UDCA while 58 had placebo intervention. The study showed significant decrease in liver counts with improved myocardial to liver ratio at 30 and 60 minutes in adenosine stress MPS group, and marginally significant alteration in liver counts at 60 minutes in viability MPS group receiving UDCA, resulting in better images.

CONCLUSION

UDCA intervention in MPS provides early and better image due to faster hepatic tracer clearance.

摘要

背景

在评估冠心病患者时，Tc-MIBI SPECT/CT 心肌灌注闪烁显像（MPS）中，由于持续性肝活性导致的心下示踪剂活性会干扰下壁和下间隔壁的评估。这会增加研究时间，从而影响图像解读。熊去氧胆酸（UDCA）已知可增强胆红素和胆汁盐的肝排泄，但其在促进心脏成像方面增强肝示踪剂清除的作用尚不清楚。

方法

这是一项针对 120 名因腺苷应激或存活 MPS 研究而转诊的患者的前瞻性、随机、双盲、安慰剂对照临床试验，患者按 1:1 随机分为 UDCA 或安慰剂组。结果是改善图像质量，以便更好地解释，并减少扫描等待时间。

结果

118 名参与者（59±11.9 岁；84 名男性）接受了腺苷应激 MPS 或存活 MPS。60 名参与者接受了 UDCA 治疗，而 58 名参与者接受了安慰剂干预。研究表明，在腺苷应激 MPS 组中，肝脏计数在 30 分钟和 60 分钟时显著下降，心肌与肝脏的比值提高，而在接受 UDCA 的存活 MPS 组中，肝脏计数在 60 分钟时略有显著变化，从而得到更好的图像。