实验性顿抑心肌微灌注及局部功能与细胞凋亡的关系  

Experimental study of relationship on myocardial perfusion, regional contractile function and cell apoptosis in stunned myocardium by myocardial contrast echocardiography with computer-aided technique

作　　者：杜国庆[1] 田家玮[1] 张萌[1] 宿阳[1] 郭延辉 

机构地区：[1]哈尔滨医科大学附属第二医院超声科心肌缺血机理与诊疗技术省部共建教育部重点实验室 (哈尔滨医科大学),150086 [2]Department of Radiology, University of Michigan, USA

出　　处：《中华超声影像学杂志》2011年第1期67-71,共5页Chinese Journal of Ultrasonography

基　　金：基金项目：教育部高等学校博士学科专项科研基金（20092307110017）;黑龙江省自然科学基金（D201078）;黑龙江省政府博士后资助基金（LRB09-361）;黑龙江省教育厅科学技术研究面上项目（11551286）;哈尔滨医科大学附属第二医院科研基金（BS2009-20）

摘　　要：目的 评价计算机辅助心肌造影（MCE）对顿抑心肌微灌注定量研究的可行性,探讨顿抑心肌的微灌注及局部功能与细胞凋亡的关系.方法 根据阻断和再灌注冠脉时间不同,将家兔分为三组：阻断15 min再灌注30 min（Ⅰ组）、阻断30 min再灌注60 min（Ⅱ组）和阻断120 min再灌注60 min（Ⅲ组）.于冠脉阻断时和再灌注后行MCE,造影图像经自制计算机辅助软件处理后,自动得出每个节段的标化造影剂密度（CI） 对危险心肌的室壁增厚率（WT）进行计算 应用末端脱氧核糖核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）检测心肌细胞凋亡情况,并计算凋亡指数（AI）.结果 ①阻断时,各组危险心肌的WT均降至零点或呈负值,且标化CI值均明显减低,与基础状态比较差异有统计学意义（P＜0.01）.再灌注后,各组危险心肌的WT均明显低于基础状态 而Ⅰ组和Ⅱ组危险心肌标化CI值比阻断时增高（P＜0.01）,与基础状态时相比仍减低（P＜0.01）,Ⅲ组危险心肌标化CI值与阻断时相比无明显差别（P＞0.05）.②各组危险心肌的AI分别为（13.70±5.48）%、（36.25±5.55）%和（62.06±6.70）%,组间比较差异均有统计学意义（P＜0.05或P＜0.01 危险心肌WT和标化CI与AI均呈负相关（r=-0.87和r=-0.77,P＜0.05）.结论 计算机辅助心肌造影可定量评估心肌微灌注,短时间缺血再灌注不会引起心肌坏死,但会导致心肌细胞发生凋亡,出现心肌顿抑现象,长时间缺血后,即使给予充足的再灌注,也会导致凋亡和坏死同时发生.Objective To evaluate a new computer-aided technique applicable for myocardial contrast echocardiography（MCE） to quantitate automatically calibrated myocardial contrast intensity（CD and to test the feasibility of calibrated CI in assessing myocardial perfusion. To analyze the relationship on myocardial perfusion,regional contractile function and cell apoptosis in stunned myocardium. Methods According to coronary occlusion and reperfusion at different times, rabbits were divided into three groups： 15 min occlusion/30min reperfusion （group Ⅰ ）,30 min occlusion / 60min reperfusion （group Ⅱ ） and 120 min occlusion / 60min reperfusion （group Ⅲ ）. MCE was performed on all rabbits at baseline,occlusion and after reperfusion,and its images were analyzed by a new computer-aided technique. Myocardial calibrated CI of each segment was measured automatically by software. Percentage wall thickening （WT） of each risk segment at each stage were also measured by echocardiography. The apoptotic index（AI） in regional left myocardial dysfunction was calculated by terminal deoxynucleotidyl transferease-mediated biotinylated deoxyuridine triphosphate nick end labeling（TUNEL ）. Results （1） During occlusion, WT in the areas at risk decreased to zero or negative and the calibrated CI values were significantly lower than those at baseline （ P 〈0.01 ）. After reperfusion, WT in all risk segment remained depressed, but calibrated CI significantly improved in group Ⅰ and Ⅱ while those remained unchanged in group Ⅲ. （2）AI in risk myocytes were （13. 70 ± 5.48 ） %, （36.25 ± 5.55 ） % and （ 62.06 ± 6. 70 ） %, respectively, both statistically significant difference between the two groups （ P 〈0.05 or P 〈 0.01 ）. AI were negatively correlated to WT and calibrated CI （ r = - 0. 87 and r = - 0. 77, P 〈0.05）. Conclusions MCE with computer-aided technique can assess quantitatively myocardial perfusion and regional contractile function. Short-term ischemiareperfusion

关 键 词：超声心动描记术 微气泡 图像处理 计算机辅助 心肌再灌注 细胞凋亡 

分 类 号：R54[医药卫生—心血管疾病]