核素显像评价自体骨髓单个核细胞移植治疗心肌梗死后心力衰竭  

Scintigraphic assessment of the effects of bone marrow mononuclear cells transplantation in patients with heart failure after myocardial infarction

作　　者：张卫方[1] 张燕燕[1] 徐艳[1] 马婧[1] 李欣欣[1] 王荣福[2] 

机构地区：[1]北京大学第三医院核医学科,北京100083 [2]北京大学第一医院核医学科,北京100034

出　　处：《中国医学影像技术》2009年第2期297-300,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的核素显像观察经冠状动脉自体骨髓单个核细胞移植治疗后心肌梗死心力衰竭患者的心肌血流灌注及心功能的变化,研究自体骨髓单个核细胞移植对于心肌修复和心功能的影响。方法24例前壁心肌梗死合并心力衰竭的患者,非随机法(患者意愿)分为两组。细胞移植组(BM-MNCs组)10例,经冠状动脉骨髓细胞注射+介入治疗+标准药物治疗;对照组14人,介入治疗+标准药物治疗。所有患者分别于移植术前、术后12个月行超声心动、心肌灌注静息显像及平衡法门控心室显像。结果术后12个月BM-MNCs组心肌血流灌注评分明显改善(46.67±3.44 vs 29.00±4.50,P= 0.0015),对照组较术前无明显改变(46.33±2.80 vs 47.00±4.12,P>0.05),两组间差异具有统计学意义(29.00±4.50 vs 47.00±4.12,P=0.0157)。BM-MNCs组心肌梗死区面积明显减少[(38.00±3.86)%vs(29.44±4.73)%,P=0.0009],对照组术后无显著变化[(32.70±5.02)%vs(30.30±4.92)%],两组间的变化无统计学意义。门控心血池显像结果示:移植组术后12个月LVEF值可见轻度升高,但是差异无统计学意义,结果与超声心动图一致。结论核素心肌显像对心肌梗死后心力衰竭患者BM-MNCs移植后的疗效判断有重要价值,自体骨髓单个核细胞移植后,心肌梗死区域血流灌注得到了明显的改善,心功能得到一定的提高。Objective To assess the effects of bone marrow mononuclear cells transplantation（BM-MNCs）with nuclear imaging in patients with heart failure after myocardial infarction.Methods Twenty-four anterior myocardial infarction patients with heart failure were enrolled and divided into two groups：BM-MNCs,PCI＋cell transplantation,10 patients,and control,PCI only,14 patients.All patients were received myocardial perfusion imaging（MPI）and gated ventricular imaging before and 12 months after treatment as baseline and follow up evaluations.At the same time,2D echocardiogram was performed.Results Twelve months after treatment,the myocardial perfusion was significantly improved in BM-MNCs group （46.67±3.44 vs 29.00±4.50,P=0.0015）,but not in control group（46.33±2.80 vs 47.00±4.12,P〉0.05）.Infarct size decreased in BM-MNCs group（[38.00±3.86]%vs[29.44±4.73]%,P=0.0009）,compared with that of the control group（[32.70±5.02]% vs[30.30±4.92]%,P〉0.05）.Gated ventricular imaging results showed that LVEF was improved mildly in BM-MNCs group,but the difference between two groups was not significant（P〉0.05）,while ecbocardiogram had the similar results.Conclusion MPI and gated ventricular imaging can provide useful information to evaluate the effects of BM-MNCs transplantation in patients with ischemic heart failure.Although long-term follow-up of the therapeutic outcome and randomized trial are required,BM-MNCs seems to have the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.

关 键 词：心肌梗死 心力衰竭 放射性核素显像 

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