^(99m)Tc-MIBI心肌显像评价犬急性心肌梗塞激光心肌血管重建术治疗的效果  

Evaluation of the effectiveness of laser transmyocardial revascularization for acute myocardial infarction in dogs using ^(99m)Tc-MIBI myocardial imaging

作　　者：刘生[1] 陈矩[1] 梁宏[2] 李伟明[2] 李春亿[2] 

机构地区：[1]中山大学附属第二医院,广东广州510120 [2]中山大学附属第一医院核医学科,广东广州510080

出　　处：《中国临床医学影像杂志》2004年第9期499-501,共3页Journal of China Clinic Medical Imaging

摘　　要：目的:评价心肌灌注显像在激光心肌血管重建术(TMR)治疗急性心肌梗塞(AMI)的作用。方法:心梗犬(n=9)和心梗后即刻TMR犬(n=12)术后24小时行99mTc-MIBI心肌灌注显像,靶心图定量测定缺损分数,与术后24小时以上不同时间的TTC测定的梗塞面积与左室面积之比的比较。同时,进行心肌组织学检查和评价犬的生存率。结果:①所有犬均见左室前壁和心尖区放射性分布明显稀疏或缺损,但激光组所见的缺损范围明显较梗塞组小,心梗组缺损分数DF(0.35±0.05,n=9)高于激光处理组(0.30±0.06,n=12),P<0.05。激光组梗塞面积和左室面积比IS?LV(0.07±0.05,n=11)明显小于心梗组(0.18±0.06,n=8),P<0.05。②HE染色显示心梗组(术后14～90天)均见广泛的陈旧性心梗;激光组(术后30～90天)可见心肌坏死和炎性肉芽及瘢痕形成呈灶性分布,不同时期切片还可见到开放或半开放的陈旧激光管道,伴有内皮形成,腔内和周围心肌间隙均可见较多红细胞。管道周围见丰富的新生小血管。③心梗组生存时间犤(18.0±2.7)天犦明显短于激光处理组犤(51.3±3.4)天犦,P<0.05。结论:TMR能有效地增加缺血心肌的血流灌注,减轻AMI后的心肌细胞损害,缩小心梗范围,提高AMI动物的生存率;99mTc-MIBI心肌灌注显像可准确评价犬AMI行TMR后的局部心肌血流灌注状况。Objective: To evaluate the effectiveness of laser transmyocardial revascularization(TMR) for acute myocardial infarction(AMI) in dogs using 99mTc-MIBI SPECT imaging. Methods: Control dogs of AMI(n=9) and the TMR dogs(n=12) all underwent 99mTc-MIBI SPECT imaging 24 hours post-operation, the radioactive defect fraction(DF) of the left ventricle was measured using Bull's eye analysis, and the results were compared with the ratio of the infarct size to the left ventricle(ISLV) by TTC method in different time intervals after 24 hours. HE staining was also done and survival of dogs was evaluated. Results: ①99mTc-MIBI SPECT imaging showed the radioactive defect in anterior wall and apex of left ventricular myocardium in all dogs, but the extent of defect was smaller in TMR dogs than in control dogs. DF in the AMI(0.35±0.05, n=9) was larger than in the TMR(0.30±0.06, n=12), P<0.05. ISLV in AMI(0.18±0.06, n=8) was larger than that in TMR(0.07±0.05, n=11), P<0.05. ②HE staining showed wide old myonecrosis in AMI dogs, but in TMR, old MI was mostly local, and the extent of MI was small. Some patent laser channels with evidence of endothelialization was all seen, a number of erythrocytes filled the cavities of channels and permeated into the adjacent myocardial interstitium, and there were many small vessels around the channels. ③the survival time in AMI(18.0±2.7)days was shorter than that in TMR(51.3±3.4)days, P<0.05. Conclusion: TMR could effectively increase vascular supply to the ischemic myocardium, alleviate ischemic damage and decrease the infarct areas, and raise survival rate of animals with AMI. 99mTc-MIBI SPECT imaging could accurately, noninvasively evaluate the myocardial perfusion post TMR in dogs with AMI, and it also could predict the therapeutic effectiveness of TMR.

关 键 词：心肌梗塞 放射性核素显像 99M锝SESTAMIBI 心肌血管重建术 

分 类 号：R542.22[医药卫生—心血管疾病] R817.4[医药卫生—内科学]