三维超声心动图评价基因转染骨髓基质细胞移植治疗慢性缺血性心脏病价值  

Evaluation of chronic ischemic myocardium before and after transplantation of bone marrow stromal cell transferred by angiogenin gene with three-dimensional echocardiography

作　　者：徐静[1] 赵宝珍[1] 黄盛东[2] 王韦[1] 龚德军[2] 崔勇[2] 贾宝成[2] 

机构地区：[1]上海第二军医大学长海医院超声科,200433 [2]上海第二军医大学长海医院胸心外科实验室,200433

出　　处：《上海医学影像》2005年第1期29-32,共4页Shanghai Medical Imaging

摘　　要：目的探讨动态三维超声心动图(DTDE)评价基因转染骨髓基质细胞(BMSCs)移植治疗慢性缺血心肌价值。方法在猪冠脉左旋支放置Ameroid环建立慢性心肌缺血模型;4周后分组注射编码血管生长素(ANG)基因的腺病毒(Ad.)转染的自体BMSCs(组Ⅰ)、编码ANG基因的Ad.(组Ⅱ)、单纯自体BMSCs(组Ⅲ)和空Ad.磷酸盐缓冲液(组Ⅳ)。再4周后行病理学检查。分别于正常、置环后4周和注射后4周开胸时采集二维图像,应用TomTec三维重建和分析技术,观察各时期左室形状和室壁运动、计算左室侧后壁(LPW)局部收缩功能和容积的变化。结果慢性心肌缺血模型均出现左室重构和LPW室壁运动明显减弱,LPW各节段舒张末期容积(EDV)增大,射血分数(EF)降低(P<0.01)。注射后4周,组Ⅰ～Ⅲ均不同程度出现左室重构现象减轻,LPW各节段EDV缩小(P<0.05～0.01),EF增大(P<0.05～0.01),其中以组Ⅰ治疗效果最好,尤以左室后壁基底部容积减小及后壁基底部和中间部收缩功能改善最为显著(P<0.05)。组Ⅳ与缺血时无明显差异(P>0.05)。结论DTDE对评价基因转染细胞移植治疗慢性缺血性心脏病左室容积和收缩功能的变化具有重要意义,表明这种治疗对左室各节段容积和收缩功能的改善是不一致的。Objective To evaluate the value of Dynamic Three-dimensional echocardiography (DTDE) in detecting chronic ischemic myocardium before and after transplantation of bone marrow stromal cells (BMSCs) combined with angiogenic gene(ANG) transfer. Methods Four weeks after chronic ischemic myocardium models were set up, groupⅠ,Ⅱ,Ⅲ and Ⅳ were intramyocardially administrated with BMSCs transferred by Adenovirus mediated ANG (Ad·ANG), Ad·ANG, BMSCs and null Adenovirus phosphate buffer respectively. Four weeks later, Pathological investigations were performed. The DTDE using TomTec reconstruction system at normal state, 4 weeks after Ameroid placement and 4 weeks after administration were performed to analysis the shape, volume and wall motion changes of left ventricle. Results Left ventrical (LV) remodeled and weakness of lateral-posterior wall (LPW) motion emerged 4w after Ameroid placement. The end-diastolic volume of left ventricle (EDV) were all increased and the ejection fraction (EF) all decreased (P<0.01). After administration, group Ⅳ remained increased volume and decreased EF compared with that before administration (P<0.05). GroupⅠ,Ⅱ and Ⅲ had improvement of LV remodeling, decrease regional EDV of LPW and increase EF (P<0.05～0.01). The greatest increase of EDV in baseline and middle PW and that of EF in baseline PW were found in Group Ⅰ(P<0.05). Conclusions DTDE is a feasible approach to assess regional LV volumes and systolic function changes in chronic ischemic myocardium before and after gene transfer and cell transplantation therapy.

关 键 词：移植治疗 左室 三维超声心动图 缺血性心脏病 慢性 收缩功能 基因转染 注射 室壁运动 骨髓基质细胞移植 

分 类 号：R542.22[医药卫生—心血管疾病] R541[医药卫生—内科学]