目的探讨 18F-NaF PET/CT冠状动脉斑块显像评估冠状动脉粥样硬化性心脏病(CAD)患者长期预后的临床价值。
方法选取2015年9月至2022年10月多中心临床已确诊的54例CAD患者[男37例，女17例，年龄(57.2±9.8)岁]进行回顾性队列研究。患者在1周内完成 18F-NaF PET/CT及冠状动脉造影(CAG)检查，PET/CT显像均在山西医科大学第一医院进行。随访患者治疗后主要心血管不良事件(MACE)。建立ROC曲线，获得SUV max及冠状动脉主要分支所有病灶处SUV max累积值(S-SUV max)预测MACE的最佳阈值，采用Cox比例风险模型和Kaplan-Meier方法(log-rank检验)分析PET参数对MACE的预测价值。组间代谢参数差异行Mann-Whitney U检验。
结果54例患者中位随访时间为6.0(1.8，6.6)年，13例(24.1%)发生MACE，包括7例死亡、5例心肌梗死、1例严重心律失常。MACE患者S-SUV max明显高于非MACE组[2.64(2.08，4.49)与1.83(0.95，2.90)； Z＝－2.04， P＝0.041]；ROC曲线示S-SUV max预测MACE的最佳阈值为2.05(AUC＝0.690)；多因素Cox分析示，S-SUV max是MACE的强力预测因子[风险比( HR)＝2.434(95% CI：1.547～3.828)， P<0.001]。ROC曲线示SUV max预测MACE的最佳阈值为0.55(AUC＝0.659)，单因素Cox分析示SUV max是预测MACE的因素[ HR＝10.192(95% CI：2.667～38.953)， P＝0.001]。在25例不完全血运重建(ICR)患者中，Kaplan-Meier分析示， 18F-NaF摄取阳性者[单支中度狭窄(狭窄40%～70%)病变处SUV max≥0.55]MACE发生率明显高于 18F-NaF摄取阴性者(5/14与0/11; χ 2＝6.07， P＝0.014)。
结论 18F-NaF PET/CT可作为CAD患者MACE的独立预测因子，并可定量评估中度冠状动脉狭窄的远期进展情况；未来其有望成为一种无创指导冠状动脉多支病变再血管化治疗决策的新方式。
ObjectiveTo investigate the clinical value of 18F-NaF PET/CT coronary plague imaging in evaluating the long-term prognosis of patients with coronary artery disease (CAD).
MethodsA retrospective cohort study was conducted among 54 patients (37 males and 17 females, aged (57.2±9.8) years) diagnosed with CAD from a multicenter study between September 2015 and October 2022. All patients underwent 18F-NaF PET/CT and coronary angiography (CAG) within 1 week, and the PET/CT imaging was performed at the First Hospital of Shanxi Medical University. Major adverse cardiovascular events (MACE) were followed up. ROC curves were established to obtain the optimal thresholds of SUV max and accumulated SUV max of all lesions of main coronary artery branches (S-SUV max) for predicting MACE. Cox proportional risk model and Kaplan-Meier method (log-rank test) were used to analyze the predictive value of PET parameters for MACE. Differences in metabolic parameters between 2 groups were compared by Mann-Whitney U test.
ResultsThe median follow-up time of the 54 patients was 6.0(1.8, 6.6) years, and 13(24.1%) patients developed MACE, including 7 deaths, 5 myocardial infarction and 1 severe arrhythmia. S-SUV max in MACE group was significantly higher than that in the non-MACE group (2.64(2.08, 4.49) vs 1.83(0.95, 2.90); Z=-2.04, P=0.041). ROC curve showed that the optimal threshold of S-SUV max for MACE prediction was 2.05 (AUC=0.690). Multivariate Cox analysis showed that S-SUV max was a strong predictor of MACE (hazard ratio ( HR)=2.434(95% CI: 1.547-3.828), P<0.001). ROC curve showed that the optimal threshold of SUV max to predict MACE was 0.55 (AUC=0.659), and univariate Cox analysis showed that SUV max was a factor to predict MACE ( HR=10.192 (95% CI: 2.667-38.953), P=0.001). In 25 patients with incomplete revascularization (ICR), Kaplan-Meier analysis showed that the incidence of MACE in patients with positive 18F-NaF uptake (single medium stenosis (40%-70%) with SUV max≥0.55) was significantly higher than that in patients with negative 18F-NaF uptake (5/14 vs 0/11; χ 2=6.07, P=0.014).
Conclusions 18F-NaF PET/CT can be used as an independent predictor of MACE in patients with CAD and can quantitatively assess the long-term progression of moderate coronary artery stenosis. In the future, it is expected to be a new non-invasive way to guide the revascularization treatment decision of multi-vessel CAD.
宇雪,李莉,靳春荣,等. 18F-NaF PET/CT冠状动脉斑块显像预测冠心病患者预后的价值 [J]. 中华核医学与分子影像杂志,2025,45(02)：65-70.
DOI:10.3760/cma.j.cn321828-20240228-00074版权归中华医学会所有。
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宇雪：研究实施、统计学分析、论文撰写；李莉：研究设计及指导、论文修改、经费支持；靳春荣、洪钰、宋佳林、王波、王慧峰、司新成、师晓丽：研究实施；武志芳、李思进：研究指导、经费支持
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