核素心肌显像动态评价小型猪冠状动脉慢性闭塞性病变的心肌灌注、代谢和左心室功能变化  

Serially evaluation of changes in myocardial perfusion,hibernation myocardium and left ventricular function in the development of chronic coronary artery occlusion by gated SPECT perfusion and gated PET imaging in pigs

作　　者：张颖[1] 田毅 牟甜甜[1] 贠明凯 朱紫薇 鲁瑶 孟晶晶[1] 董薇[1] 李翔 张晓丽[1] Zhang Ying;Tian Yi;Mou Tiantian;Yun Mingkai;Zhu Ziwei;Lu Yao;Meng Jingjing;Dong Wei;Li Xiang;Zhang Xiaoli(Department of Nuclear Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院核医学科,北京100029

出　　处：《中华核医学与分子影像杂志》2022年第5期284-288,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81871377,81571717)。

摘　　要：目的建立小型猪冠状动脉慢性进行性心肌缺血模型,动态评估血管进行性狭窄至闭塞过程中左心室(LV)整体功能、心室重构、心肌灌注和存活性的变化特点。方法中华小型猪8头(雄性5头,雌性3头;10月龄),在冠状动脉左前降支第1对角支分叉处以下1 cm处放置Ameroid环,建立慢性心肌缺血模型,在不同时间点(术前及术后1、4和8周)分别行门控^(99)T^(cm)-甲氧基异丁基异腈(MIBI)SPECT/CT显像、门控^(18)F-FDG PET/CT心肌代谢显像、冠状动脉造影(CAG),动态评价LV射血分数(LVEF)、LV舒张末期容积(LVEDV)、LV收缩末期容积(LVESV)、室壁运动异常总积分(SMS)、室壁增厚率异常总积分(STS)、心肌总灌注缺损程度(TPD)、存活心肌面积(HM)的变化。采用单因素重复测量方差分析、Kruskal-Wallis检验和Bonferroni校正法分析数据。结果8头中华小型猪建模成功,7头完成术前及术后1、4和8周显像。显像示TPD进行性增大,在术前及术后1、4和8周差异有统计学意义[0、12.0%(0,33.0%)、(41.1±23.7)%、(49.3±24.5)%;H=17.03,P=0.001];HM在术前为100%,在术后1周[21.0%(6.0%,100%)]至4周[18.0%(3.0%,33.0%)]逐渐减少,8周[(23.0±15.4)%]较4周增加,组间差异有统计学意义(H=13.09,P=0.004),但术后1与4周、4与8周两两比较差异无统计学意义[均P>0.05(Bonferroni校正法)];LVEF逐渐降低,在术前及术后1、4和8周分别为(73.7±8.4)%、(63.7±19.1)%、(53.7±14.6)%、(49.9±15.4)%,差异有统计学意义(F=6.22,P=0.004);LVEDV[9.0(6.0,21.0)、(31.4±16.3)、(32.9±17.4)和(36.4±17.5)ml]和LVESV[(3.8±3.2)、(15.9±15.3)、12.0(10.0,17.0)和(19.3±10.9)ml]均随时间逐渐增大,差异均有统计学意义(H值:8.58、10.51,P值:0.035、0.015);SMS及STS随时间均逐渐增加,差异也均有统计学意义(H值:16.49、13.33,P值:0.001、0.004)。结论在冠状动脉慢性狭窄过程中,心肌灌注受损范围和程度逐渐加重,HM逐渐减少,相应的LV功能、心室重构逐渐恶化;之后,�Objective To serially characterize the myocardial perfusion,myocardial hibernation and left ventricular(LV)function as well as LV remodeling in progressive coronary artery stenosis in Chinese mini-pigs.Methods In 8 Chinese mini-pigs(5 males,3 females;age:10 months),chronic progression of coronary stenosis and finally occlusion was established using Ameroid constrictor implantation at the 1 cm below the bifurcation of the first diagonal branch of the left anterior descending(LAD)artery.Serial gated^(99)T^(cm)-methoxyisobutylisonitrile(MIBI)SPECT/CT,gated^(18)F-FDG PET/CT imaging and coronary angiography(CAG)were performed before surgery and at the 1st,4th and 8th week after surgery.Longitudinally,total perfusion defect(TPD),LV ejection fraction(LVEF),LV end-diastolic volume(LVEDV),LV end-systolic volume(LVESV),summed motion score(SMS),summed thickening score(STS)and hibernating myocardium(HM)were analyzed.Repeated measures analysis of variance,Kruskal-Wallis rank sum test and Bonferroni correction method were used to analyze data.Results One mini-pig died of infection after the Ameroid constrictor implantation.In the remaining 7 mini-pigs,TPD was progressively increased with time prolonged(0,12.0%(0,33.0%),(41.1±23.7)%and(49.3±24.5)%;H=17.03,P=0.001);Compared with HM before the surgery(100%),HM was gradually reduced from the 1st(21.0%(6.0%,100%))to the 4th(18.0%(3.0%,33.0%))week after surgery,and then increased to the 8th week after surgery((23.0±15.4)%;H=13.09,P=0.004),but there was no significant difference between the 1st and 4th week,or between the 4th and 8th week after surgery(both P>0.05(Bonferroni correction method)).Accordingly,LVEF gradually decreased((73.7±8.4)%,(63.7±19.1)%,(53.7±14.6)%and(49.9±15.4)%;F=6.22,P=0.004).LVEDV(9.0(6.0,21.0),(31.4±16.3),(32.9±17.4)and(36.4±17.5)ml;H=8.58,P=0.035)and LVESV((3.8±3.2),(15.9±15.3),12.0(10.0,17.0)and(19.3±10.9)ml;H=10.51,P=0.015)gradually increased.SMS and STS continuously increased as well(H values:16.49,13.33,P values:0.001,0.004).Conclusions With

关 键 词：冠状动脉闭塞 心肌灌注显像 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 99M锝甲氧基异丁基异腈 正电子发射断层显像术 氟脱氧葡萄糖F18 猪 

分 类 号：R817.4[医药卫生—影像医学与核医学] R541.4[医药卫生—放射医学]