联合显像对冠状动脉搭桥术后不同时间点自体骨髓干细胞移植治疗心肌梗死的疗效评价  

Multi-modality imaging in the patients with myocardial infarction after coronary artery bypass graft and autologous bone marrow stem cell transplantation

作　　者：陆国秀[1] 郝珊瑚[1] 王治国[1] 张彤[1] 王辉山[2] 张国旭[1] 

机构地区：[1]沈阳军区总医院核医学科,110016 [2]沈阳军区总医院心外科,110016

出　　处：《中华核医学与分子影像杂志》2017年第6期321-325,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：辽宁省科学技术计划项目（2012225019）

摘　　要：目的 探讨PET/CT、CAG、CMRI联合显像对陈旧性心肌梗死患者冠状动脉（简称冠脉）搭桥术后不同时间点自体骨髓干细胞移植治疗的疗效评估价值.方法 前瞻性研究2012年1月至2012年12月间43例陈旧性心肌梗死患者（男27例、女16例,年龄47~72岁）,分别在冠脉搭桥术后0~3 d（组1,18例）,4~14 d（组2,13例）及15~30 d（组3,12例）进行自体骨髓干细胞移植.治疗前、后不同时间点依次接受CMRI、门控13N-NH3＆#183;H2O/18F-FDG PET/CT及CAG检查.按照AHA推荐的17节段模型法,比较受累冠脉狭窄程度、LVEF、梗死百分比（PSI）、心肌灌注/代谢异常节段数及放射性分布评分K值在不同时间点的差异.采用单因素方差分析和最小显著差异t检验处理数据.结果 PET/CT诊断病理性心肌的灵敏度、特异性、阳性预测值及阴性预测值分别为95.4%（540/566）、87.3%（144/165）、96.3%（540/561）及84.7%（144/170）.3组患者治疗后12个月血管狭窄程度改善明显[（69.1±9.5）%;F=12.854, P＜0.05],较治疗前冠脉血管扩张[（74.8±7.9）%;t=3.074,P＜0.05].与治疗前比较,3组患者LVEF均有不同程度升高,但差异无统计学意义（F值：0.906、0.298和0.059,均P＞0.05）.组2患者治疗后12个月PSI明显下降[（35.70±12.59）%;F=3.792,t值：-2.916~4.059,均P＜0.05）,治疗后1及12个月放射性评分K值较治疗前明显减低（11.79±1.87、12.39±2.35及14.05±2.15;F=4.212, t值：-4.619和-0.989,均P＜0.05）,治疗后1个月心肌灌注/代谢不匹配节段数低于治疗前及治疗后24个月[（10.17±0.66）、（12.92±0.99）和（14.17±1.21）个;F=3.543, t值：-2.146和-2.898,均P＜0.05].组1和组3患者治疗前后PSI、K值及不匹配节段数放射性分布差异均未见统计学意义（F值：0.093~1.364,均P＞0.05）.结论 PET/CT、CAG联合CMRI显像可以提高病理性心肌的检出率;冠脉搭桥术后4~14 d行自体骨髓干细胞移植治疗可以短期内提高存活心肌�Objective To evaluate the value of multi-modality imaging （PET/CT＋CAG＋CMRI） in post myocardial infract （MI） patients followed coronary artery bypass graft （CABG） and autologous bone marrow stem cell （BMSC） therapy.Methods A total of 43 patients with MI （27 males, 16 females, age range： 47-72 years） were prospectively enrolled in the year 2012 between January and December.All patients underwent CABG＋BMSC transplantation and were divided into 3 groups according to the time interval between two treatments （group 1： 0-3 d;group 2： 4-14 d;group 3： 15-30 d）.All patients were orderly scanned with CMRI, PET/CT （13N-NH3＆#183;H2O/18F-FDG） and CAG at different time-points pre-/post-treatment.The quantitative parameters included vascular stenosis degree（VSD）, LVEF, percentage size of infarction （PSI）, the number of segments in mismatched myocardial perfusion/metabolic and the K value for radioactive distribution grading.One-way analysis of variance and the least significant difference t test were used to compare parameters before and after treatment in the same group and among three different groups.Results Regarding PET/CT diagnostic efficacy of abnormal myocardial segments, the sensitivity, specificity, positive predictive value and negative predictive value were 95.4%（540/566）, 87.3%（144/165）, 96.3%（540/561） and 84.7%（144/170）, respectively.After CABG and BMSC transplantation treatments for 12 months, VSD decreased significantly（（69.1±9.5）%;F=12.854, P〈0.05）, comparing with the baseline （（74.8±7.9）%;t=3.074, P〈0.05）.Comparing to the baseline, LVEF in 3 groups increased slightly（F values： 0.906,0.298,0.059, all P〉0.05）.PSI of patients in group 2 decreased greatly after 12 months treatment （（35.70±12.59）%;F=3.792, t values：-2.916-4.059, all P〈0.05）.K values for radioactive distribution grade decreased obviously after 1 month and 12 months treatment comparing to the baseline （11.79±1.87,12.39±2.35,14.05±2.15;F=

关 键 词：心肌梗塞 干细胞移植 移植 自体 冠状动脉分流术 正电子发射断层显像术 体层摄影术 X线计算机 冠状血管造影术 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.22[医药卫生—诊断学] R817.4[医药卫生—临床医学]