联合显像在冠脉搭桥联合干细胞移植治疗心肌梗死疗效评估中的价值

发布时间：2018-05-04 03:33

本文选题：心肌梗塞 + 心肌血管重建术　；参考：《中国组织工程研究》2017年33期

【摘要】：背景:干细胞对于陈旧性心肌梗死的治疗效果仍存在一定争议。干细胞移植治疗后多模态影像评价技术是目前研究的关键点之一,其可以从分子影像学角度评估干细胞移植疗效。目的:影像学评估冠脉搭桥术联合不同干细胞移植治疗陈旧性心肌梗死患者的疗效。方法:60例陈旧性心肌梗死患者,完全随机分为3组(n=20),分别接受单纯冠脉搭桥、冠脉搭桥+骨髓干细胞及冠脉搭桥+外周血干细胞移植治疗。治疗前,治疗后1,12,24个月依次接受心脏超声、门控13N-NH3·H2O/18F-FDG PET/CT及冠脉血管造影检查。比较受累冠脉狭窄程度、左室射血分数、13N-NH3·H2O心肌血流灌注/18F-FDG代谢异常心肌放射性分布评分值(定义为A值)及缺损面积比(定义为R值)。结果与结论:(1)门控13N-NH3·H2O/18F-FDG PET/CT诊断存活心肌的灵敏度、特异度、阳性预测值及阴性预测值分别为92.1%,85.6%,93.4%及78.4%;(2)3组患者治疗后血管狭窄程度均较治疗前改善(P0.05),以治疗后1个月效果显著(P0.05);(3)与治疗前比较,冠脉搭桥+骨髓干细胞组、冠脉搭桥+外周血干细胞组治疗后左室射血分数升高(P0.05);(4)冠脉搭桥+骨髓干细胞组治疗前、后不同时间点异常心肌放射性分布评分A值减低。与治疗前相比,治疗后1个月及治疗后24个月差异有显著性意义(P0.05),治疗后24个月较治疗后12个月也进一步降低(P0.05);(5)与治疗前相比,冠脉搭桥+骨髓干细胞组患者治疗后1个月心肌灌注/代谢缺损面积比显著降低(P=0.019);(6)结果表明,联合多模态显像,可以从不同角度更好地评价冠脉搭桥联合干细胞移植治疗陈旧性心肌梗死的疗效。门控13N-NH3·H2O/18F-FDG PET/CT对存活心肌诊断准确性高,有利于心肌梗死患者治疗方式的选择及疗效评估;冠脉搭桥基础上联合干细胞移植治疗有助于短期内提高患者的左心室功能;与冠脉搭桥+外周血干细胞移植相比,冠脉搭桥+骨髓干细胞移植可以有效提高存活心肌功能。
[Abstract]:Background: the efficacy of stem cells in the treatment of old myocardial infarction remains controversial. Multi-mode image evaluation technique is one of the key points in the research of stem cell transplantation. It can evaluate the effect of stem cell transplantation from molecular imaging perspective. Objective: to evaluate the effect of coronary artery bypass grafting combined with different stem cell transplantation in the treatment of old myocardial infarction. Methods 60 cases of old myocardial infarction were randomly divided into 3 groups: coronary artery bypass graft, coronary artery bypass graft bone marrow stem cell and peripheral blood stem cell transplantation. Cardiac ultrasound, gated 13N-NH3 H2O/18F-FDG PET/CT and coronary angiography were performed before, 12 and 24 months after treatment. Compared with the degree of coronary stenosis, left ventricular ejection fraction (LVEF) and ratio of defect area (defined as R value) of myocardial radioactivity distribution (defined as A value) and defect area ratio (defined as R value) of myocardial perfusion by 18F-FDG were compared. Results and conclusion: the sensitivity and specificity of gated 13N-NH3 H2O/18F-FDG PET/CT in the diagnosis of viable myocardium. The positive predictive value and negative predictive value were 92.4% and 78.4%, respectively. The degree of vascular stenosis after treatment was significantly improved in the coronary artery bypass graft bone marrow stem cell group compared with that before treatment. The left ventricular ejection fraction (LVEF) in the coronary artery bypass graft peripheral blood stem cell group (PBSC group) was increased after treatment (P 0.05). The score A of abnormal myocardial radioactivity distribution was decreased at different time points before and after coronary artery bypass graft bone marrow stem cell group. Compared with before treatment, there was a significant difference in P0.05T between 1 month after treatment and 24 months after treatment, and there was also a further decrease in P0.05 after treatment at 24 months after treatment compared with 12 months after treatment) compared with that before treatment, there was a significant difference between the two groups before and after treatment. The ratio of myocardial perfusion to metabolic defect in patients with coronary artery bypass graft bone marrow stem cell group was significantly reduced 1 month after treatment. The results showed that the combined multimodal imaging showed that the ratio of myocardial perfusion to metabolic defect was significantly decreased in patients with coronary artery bypass graft bone marrow stem cell group. The effect of coronary artery bypass grafting combined with stem cell transplantation in the treatment of old myocardial infarction can be better evaluated from different angles. Gated 13N-NH3 H2O/18F-FDG PET/CT is of high accuracy in the diagnosis of viable myocardium, which is beneficial to the choice of treatment mode and evaluation of therapeutic effect in patients with myocardial infarction, and the combination of coronary artery bypass grafting and stem cell transplantation is helpful to improve the left ventricular function in the short term. Compared with peripheral blood stem cell transplantation, bone marrow stem cell transplantation with coronary artery bypass graft can effectively improve the function of viable myocardium.
【作者单位】：解放军沈阳军区总医院核医学科;解放军沈阳军区总医院心外科;
【基金】：2012年辽宁省第一批科学技术计划(2012225019)~~
【分类号】：R542.22

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