组织追踪法评价急性心肌梗死患者自体骨髓干细胞移植后左心室节段功能  

Assessment of segmental left ventricular function by tissue tracking imaging after transplantation of autologous bone marrow stem cells in patients with acute myocardial infarction

作　　者：阮雯[1] 潘翠珍[1] 黄国倩[1] 李延林[1] 葛均波[1] 舒先红[1] 

机构地区：[1]复旦大学附属中山医院心血管病研究所,上海200032

出　　处：《中华超声影像学杂志》2005年第5期330-333,共4页Chinese Journal of Ultrasonography

摘　　要：目的应用组织追踪法评价急性心肌梗死患者自体骨髓干细胞移植后受损心肌的功能恢复情况,探讨该技术对评价左心室节段收缩功能的应用价值。方法入选的16例急性心肌梗死患者均经冠状动脉造影证实为前降支病变,通过随机双盲法分为干细胞移植组(A组,8例)和常规治疗组(B组,8例),治疗后随访1周和3个月的组织多普勒超声心动图,用组织追踪法测量心尖四腔、二腔及心尖长轴观基底段、中间段与心尖段共18个节段的位移,并根据位移曲线计算长轴方向延迟收缩节段数占总节段数比例,与左心室射血分数(LVEF)、心肌核素显像随访结果相对照。结果①A组移植后3个月缺血心肌节段位移较移植1周后明显增大(P<0.05),而B组3个月和1周节段位移差异无显著性意义(P>0.05);②A组移植后3个月延迟收缩节段比例较移植1周后明显减少(25%对9%,P<0.05),B组3个月延迟收缩节段比例亦减少,但差别无显著性意义(29%对14%,P>0.05);③A组移植后3个月LVEF值与移植后1周比较呈升高趋势[(53±9)%对(57±12)%,P>0.05],B组移植后3个月LVEF值与1周比较呈下降趋势[(54±5)%对(52±7)%,P>0.05];④A组移植后3个月梗死区即刻和延迟相心肌核素摄取均较1周增强,SPECT心肌灌注图像评分较1周时显著下降(21.75±9.60对18.75±11.80,P<0.05)。B组移植后3个月梗死区?Objective Tissue tracking was used to assess the left ventricular(LV) segmental function after autologous bone marrow stem cells(BMCs) transplantation in patients with acute myocardial infarction. Methods Sixteen patients with anterior descending coronary artery occlusion proven by angiography were randomized into BMCs transplantation group (Group A, n=8) and routine treatment group (Group B,n=8). Tissue Doppler echocardiography and scintigraphy were performed 1 week and 3 months after treatment. Off line LV segmental displacement(Ds) and delayed longitudinal contraction(DLC) were measured from apical four chamber, two chamber, and long axis views at basal, middle and apical level by tissue tracking imaging. LV ejection fraction(LVEF) was determined using Simposon′s rule. Myocardial perfusion and viability was assessed by 201-thallium scintigraphy. Results In group A, Ds of the ischemic segments increased(P<(0.05)) and DLC decreased significantly (25% vs 9%, P<(0.05)), LVEF and myocardial perfusion greatly improved[LVEF (53±9)% vs (57±12)% , P>0.05;SPECT score (21.75)±(9.60) vs (18.75)±(11.80),P<(0.05))] 3 months after transplantation,whereas no evident changes in Ds(P>(0.05)), DLC(29% vs 14%,P>(0.05)),LVEF [(54±5)% vs (52±7)%, P>(0.05)],and myocardial perfusion (SPECT score (21.75)±(8.35) vs (20.75)±(10.43),P>(0.05)) were observed in group B after 3 months. Conclusions Displacement and delayed longitudinal contraction obtained by tissue tracking imaging provided a simple, quick and noninvasive method for clinical assessment of segmental left ventricular systolic function, which could serve as modalities for the efficacy of BMCs transplantation therapy.

关 键 词：自体骨髓干细胞 心肌梗死患者 组织追踪法 移植后 节段功能 急性 组织多普勒超声心动图 经冠状动脉造影 左心室射血分数 心肌核素显像 收缩功能 干细胞移植 随机双盲法 治疗后随访 SPECT 恢复情况 应用价值 随访结果 缺血心肌 

分 类 号：R542.22[医药卫生—心血管疾病]