联合显像在冠脉搭桥联合干细胞移植治疗心肌梗死疗效评估中的价值  

Multiple imaging evaluation on the therapeutic efficacy of coronary artery bypass graft combined with autologous stem cell transplantation for myocardial infarction

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] Lu Guo-xiu;Hao Shan-hu;Wang Zhi-guo;Zhang Tong;Wang Hui-shan;Zhang Guo-xu(Department of Nuclear Medicine,Surgery, the General Hospital of Shenyang Military Command, Shenyang 110016, Liaoning Province, China;Department of Cardiac Surgery, the General Hospital of Shenyang Military Command, Shenyang 110016, Liaoning Province, China)

机构地区：[1]解放军沈阳军区总医院,核医学科,辽宁省沈阳市110016 [2]解放军沈阳军区总医院,心外科,辽宁省沈阳市110016

出　　处：《中国组织工程研究》2017年第33期5332-5338,共7页Chinese Journal of Tissue Engineering Research

基　　金：2012年辽宁省第一批科学技术计划(2012225019)~~

摘　　要：背景:干细胞对于陈旧性心肌梗死的治疗效果仍存在一定争议。干细胞移植治疗后多模态影像评价技术是目前研究的关键点之一,其可以从分子影像学角度评估干细胞移植疗效。目的:影像学评估冠脉搭桥术联合不同干细胞移植治疗陈旧性心肌梗死患者的疗效。方法:60例陈旧性心肌梗死患者,完全随机分为3组(n=20),分别接受单纯冠脉搭桥、冠脉搭桥+骨髓干细胞及冠脉搭桥+外周血干细胞移植治疗。治疗前,治疗后1,12,24个月依次接受心脏超声、门控13N-NH3·H2O/18F-FDG PET/CT及冠脉血管造影检查。比较受累冠脉狭窄程度、左室射血分数、13N-NH3·H2O心肌血流灌注/18F-FDG代谢异常心肌放射性分布评分值(定义为A值)及缺损面积比(定义为R值)。结果与结论:(1)门控13N-NH3·H2O/18F-FDG PET/CT诊断存活心肌的灵敏度、特异度、阳性预测值及阴性预测值分别为92.1%,85.6%,93.4%及78.4%;(2)3组患者治疗后血管狭窄程度均较治疗前改善(P<0.05),以治疗后1个月效果显著(P<0.05);(3)与治疗前比较,冠脉搭桥+骨髓干细胞组、冠脉搭桥+外周血干细胞组治疗后左室射血分数升高(P<0.05);(4)冠脉搭桥+骨髓干细胞组治疗前、后不同时间点异常心肌放射性分布评分A值减低。与治疗前相比,治疗后1个月及治疗后24个月差异有显著性意义(P<0.05),治疗后24个月较治疗后12个月也进一步降低(P<0.05);(5)与治疗前相比,冠脉搭桥+骨髓干细胞组患者治疗后1个月心肌灌注/代谢缺损面积比显著降低(P=0.019);(6)结果表明,联合多模态显像,可以从不同角度更好地评价冠脉搭桥联合干细胞移植治疗陈旧性心肌梗死的疗效。门控13N-NH3·H2O/18F-FDG PET/CT对存活心肌诊断准确性高,有利于心肌梗死患者治疗方式的选择及疗效评估;冠脉搭桥基础上联合干细胞移植治疗有助于短期内提高患者的左心室功能;与冠脉搭桥+外周血干细胞移植相比,�BACKGROUND:Stem cells are still controversial for the treatment of old myocardial infarction.Multimodal imaging evaluation is one of the key points in the study of stem cell transplantation,which can evaluate the therapeutic efficacy of stem cell transplantation from the perspective of molecular imaging.OBJECTIVE:To evaluate the therapeutic efficacy of coronary artery bypass graft(CABG)with different stem cell transplantation in patients with old myocardial infarction using multimodal imaging technology.METHODS:Sixty patients with old myocardial infarction were enrolled and randomly divided into three groups to receive CABG,CABG+autologous bone marrow stem cell transplantation(CABG+BMC)or CABG+autologous peripheral blood stem cell transplantation(CABG+PBSC),respectively.All the patients were scanned with gated PET/CT(13N-NH3?H2O/18F-FDG),echocardiography and coronary angiography at different time points orderly(at baseline,1,12and24months after treatment).We compared the degree of coronary stenosis(%),left ventricular ejection fraction(LVEF),percentage of defect size with myocardial perfusion/metabolic abnormal radioactive distribution(A)and the ratio of defect area(R).RESULTS AND CONCLUSION:In the diagnosis of survival myocardial segments,the sensitivity,specificity,positive predictive value and negative predictive value for the gated PET/CT were92.1%,85.6%,93.4%and78.4%,respectively.After the above treatments,the extent of coronary stenosis decreased significantly in the three groups(P<0.05),which was improved most at1month after treatment(P<0.05).In the CABG+BMC and CABG+PBSC groups,the LVEF value increased significantly after treatment(P<0.05).In the CABG+BMC group,the A value decreased significantly at1and24months after treatment as compared with the baseline(P<0.05),and the A value was further decreased,indicating a significant difference at12and24months after treatment(P<0.05).In the CABG+BMC group,the R value significantly decreased at1month after treatment compared with the baseline(P=0.019).To conclude,

关 键 词：干细胞 心肌梗死 冠脉搭桥 骨髓干细胞 外周血干细胞 正电子发射计算机断层显像 冠脉血管造影 

分 类 号：R394.2[医药卫生—医学遗传学]