2024 年第 7 期 第 0 卷

心肌灌注显像对复合杂合子家族性高胆固醇血症患者全因死亡的预测研究

Predictive value of myocardial perfusion imaging for all-cause mortality in patients with compound heterozygous familial hypercholesterolemia

作者：焦建1王绿娅2董薇1李珺奇1米宏志1秦彦文2

英文作者：Jiao Jian1 Wang Luya2， Dong Wei1 Li Junqi1 Mi Hongzhi1 Qin Yanwen2

单位：1首都医科大学附属北京安贞医院核医学科，北京100029；2北京市心肺血管疾病研究所动脉粥样硬化研究室，北京100029

英文单位：1Department of Nuclear Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Atherosclerosis Research Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：复合杂合子家族性高胆固醇血症；心肌灌注显像；全因死亡

英文关键词：Compoundheterozygousfamilialhypercholesterolemia；Myocardialperfusionimaging；All-causemortality

• 摘要：

• 目的 评估心肌灌注显像（MPI）对复合杂合子家族性高胆固醇血症（CHFH）患者全因死亡风险的预测价值。方法 对经基因检查确诊为CHFH，且在2010年6月至2022年3月于首都医科大学附属北京安贞医院核医学科行负荷+静息MPI检查的患者进行回顾性随访。图像分析采用17节段5分法获得左心室心肌血流灌注参数负荷灌注总积分（SSS）、静息灌注总积分（SRS）、灌注积分差值（SDS）。随访患者全因死亡事件，采用Cox回归方法分析与全因死亡风险有关的预测因子。通过受试者工作特征（ROC）曲线分析预测因子的效能。采用Kaplan-Meier分析和Log-rank检验比较不同组CHFH患者全因死亡发生率的差异。结果 45例CHFH患者入选，中位随访时间6（4，9）年。随访期间共11例（24.4%）患者发生全因死亡。左心室心肌血流灌注参数SSS、SRS、SDS在死亡组与存活组间差异均有统计学意义（均P＜0.05）。Cox回归分析显示SRS（风险比=1.362，95%置信区间：1.029～1.802，P=0.031）是与CHFH患者全因死亡风险相关的独立预测因子。ROC分析确定预测患者死亡的最佳截断值为SRS≥2.5分，曲线下面积为0.749。Kaplan-Meier生存曲线分析结果显示，SRS≥2.5分组患者全因死亡发生率明显高于SRS＜2.5分组患者（Log-rank χ2=14.991，P＜0.001）。结论 MPI是对CHFH患者进行全因死亡风险评估的重要影像学手段，参数SRS是预测此类患者发生死亡的重要因素。

• Objective To evaluate the predictive value of myocardial perfusion imaging (MPI) for all-cause mortality risk in patients with compound heterozygous familial hypercholesterolemia (CHFH). Methods Patients with CHFH diagnosed by genetic testing who underwent stress and rest MPI in the Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University from June 2010 to March 2022 were retrospectively followed up. Total summed stress score (SSS), total summed rest score (SRS) and summed difference score (SDS) of left ventricular myocardial perfusion parameters were obtained by 17-segment 5-point method. The patients were followed up for all-cause mortality, and Cox regression was used to analyze the predictors of all-cause mortality. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of the predictors. Kaplan-Meier analysis and Log-rank test were used to compare the incidence of all-cause mortality in different groups. Results  Forty-five patients with CHFH were enrolled and followed up for a median of 6(4,9) years. A total of 11(24.4%) patients died during the follow-up period. The left ventricular myocardial perfusion parameters SSS, SRS and SDS were significantly different between the death group and the survival group (all P＜0.05). Cox regression analysis showed that SRS (Hazard ratio=1.362, 95% confidence interval:1.029-1.802, P=0.031) was an independent predictor of all-cause mortality in patients with CHFH. ROC analysis determined that the best cut-off value for predicting death was SRS≥2.5, and the area under the curve was 0.749. Kaplan-meier survival curve analysis showed that the incidence of all-cause death in SRS≥2.5 group was significantly higher than that in SRS<2.5 group (Log-rank χ2=14.991, P＜0.001). Conclusion  MPI is an important imaging method for the risk assessment of all-cause mortality in patients with CHFH, and parameter SRS is an important factor for predicting death in such patients.