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目的:研究合并及不合并糖尿病(DM)患者n 18F－脱氧葡萄糖(FDG) PET/CT心肌代谢显像的图像质量(IQ)及影响图像质量的因素。n 方法:回顾性纳入2016年6月至2018年2月于北京安贞医院诊断的冠状动脉粥样硬化性心脏病(简称冠心病)患者196例[男174例，女22例；DM 64例；年龄(57±10)岁]。患者均行n 18F－FDG PET/CT心肌代谢显像，显像前采用口服葡萄糖＋静脉注射胰岛素法调节患者血糖。采用目测分析五分法进行IQ评分，分为IQ好(0～2分)和IQ差(3～4分)。对患者进行分组：非DM＋IQ好组(组1)、DM＋IQ好组(组2)、DM＋IQ差组(组3)，分析可能影响IQ的因素：空腹血糖(FBG)、峰值血糖(PBG)、注射n 18F－FDG时血糖(BGn 注射)、口服葡萄糖量、静脉注射胰岛素总剂量、血糖浓度增高率[(PBG－FBG)/FBG，%]和血糖浓度降低率[(PBG－BGn 注射)/PBG，%]。组间差异比较行单因素方差分析，采用Spearman相关分析各参数与IQ评分的相关性，采用logistic回归分析预测IQ的独立影响因子。n 结果:196例患者中，组1有132例(67.3%)、组2有53例(27.1%)、组3有11例(5.6%)。3组间FBG、PBG、口服葡萄糖量、血糖浓度降低率和静脉注射胰岛素总剂量差异均有统计学意义(n F值：13.074～38.371，均n P<0.05)。IQ与FBG、PBG、BGn 注射、静脉注射胰岛素总剂量和血糖浓度降低率均呈正相关(n rn s值：0.142～0.262，均n P<0.05)，口服葡萄糖量与IQ呈负相关(n rn s＝－0.324，n P<0.05)。Logistic回归分析示，FBG、PBG、BGn 注射、口服葡萄糖量、静脉注射胰岛素总剂量是所有患者IQ的影响因素，对应比值比(n OR)分别为0.687(95% n CI: 0.633～0.746)、0.786(95% n CI: 0.746～0.829)、0.631(95% n CI: 0.595～0.716)、0.897(95% n CI: 0.873～0.922)、0.680(95% n CI: 0.618～0.748)，均n P<0.01。口服葡萄糖量是DM患者IQ的影响因素[n OR＝0.940(95% n CI：0.904～0.960)，n P<0.01]。n 结论:无论有无DM，FBG、PBG、BGn 注射、口服葡萄糖量、静脉注射胰岛素总剂量均可影响n 18F－FDG PET/CT心肌代谢IQ，而口服葡萄糖量是影响冠心病合并DM患者IQ的重要因素。宜严格按照指南，采用口服葡萄糖＋静脉注射胰岛素法调节血糖浓度，并给予个体化调整，尽可能获得高质量的心肌代谢图像，同时避免患者发生低血糖。n “,”Objective:To evaluate the image quality (IQ) of n 18F-fluorodeoxyglucose (FDG) PET/CT imaging and identify its influenfial factors in diabetes mellitus (DM) and non-DM patients with coronary artery disease (CAD).n Methods:A total of 196 consecutive CAD patients (174 males, 22 females, 68 DM; age: (57±10) years) in Beijing Anzhen Hospital between June 2016 and February 2018 were retrospectively analyzed. All patients underwent n 18F-FDG myocardial PET/CT imaging. The standardized fasting+ oral glucose loading (OGL) and intravenously injection of insulin protocol was performed. According to the FDG uptake by myocardium, background activity in blood and other visceral organ nearby the heart, the IQ was visually evaluated and scored by 0-4. Zero-two was considered as good IQ, 3-4 was regarded as poor IQ. Patients were divided into three groups: group 1 (non-DM+ good IQ), group 2 (DM+ good IQ), group 3 (DM+ poor IQ). Factors which may affect IQ were analyzed, which including OGL, the injection dose of insulin, fasting blood glucose (FBG), peak blood glucose (PBG), blood glucose (BG) level at n 18F-FDG injection (BGn injnection), BG increasing rate ((PBG-FBG)/FBG, %), and BG decreasing rate ((PBG-BGn injection)/PBG, %). One-way analysis of variance, Spearman correlation analysis and logistic regression analysis were used for data analysis.n Results:There were significant differences (n F values: 13.074-38.371, all n P<0.05) of FBG, PBG, OGL, BG decreasing rate and the injection dose of insulin among group 1 (n n=132, 67.3%), group 2 (n n=53, 27.1%), group 3 (n n=11, 5.6%). All those parameters, except for OGL, were positively correlated with FDG PET/CT IQ (n rn s values: 0.142-0.262, all n P<0.05). OGL was negatively correlated with IQ (n rn s=-0.324, n P<0.05). Logistic regression analysis showed that FBG (odds ratio (n OR)=0.687, 95% n CI: 0.633-0.746), PBG(n OR=0.786, 95% n CI: 0.746~0.829), BGn injection(n OR=0.631, 95% n CI: 0.595-0.716), OGL(n OR=0.897, 95% n CI: 0.873-0.922), the injection dose of insulin(n OR=0.680, 95% n CI: 0.618-0.748) were predictive factors (all n P<0.01) for good IQ in all patients. For DM patients, OGL was the only predictive factor for good IQ(n OR =0.940, 95% n CI: 0.904-0.960; n P<0.01).n Conclusions:FBG, PBG, BGn injection, OGL, the injection dose of insulin can predict IQ for all patients with CAD. For DM patients with CAD, OGL is the only predictive factor for good IQ. A good IQ of n 18F-FDG PET/CT could be obtained in majority of CAD patients, with the standardized fasting + OGL and intravenously injection of insulin protocol and adjust according to the personal status, and prevent the hypoglycemia from happening.n