超声在基因编辑猪-猴异种并联式心脏移植术中的应用价值  

Application value of ultrasound in gene-edited pig-monkey xenogeneic heart transplantation

作　　者：周容 张亚萍[1] 廖宇 程晓萍 管玉龙[2] 潘广玉[3] 闫杰 王贤芝 苟中山 潘登科 李巅远 Zhou Rong;Zhang Yaping;Liao Yu;Cheng Xiaoping;Guan Yulong;Pan Guangyu;Yan Jie;Wang Xianzhi;Gou Zhongshan;Pan Dengke;Li Dianyuan(Department of Thoracic and Cardiac Surgery,First People's Hospital of Neijiang,Neijiang 641000,China;Extracorporeal Circulation Center,National Cardiovascular Disease Center,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Peking University International Hospital,Beijing 102206,China;Chengdu Aoge Biotechnology Co,Ltd.,Chengdu 610094,China;Department of Thoracic and Cardiac Surgery,First People's Hospital of Guangyuan,Guangyuan 628000,China;Center of Cardiovascular Disease,Affiliated Suzhou Hospital of Gusu School,Nanjing Medical University,Suzhou 215000,China;Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province,Affiliated Hospital of Electronic Science and Technology University,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,China;Department of Cardiovascular Surgery,Affiliated Suzhou Hospital of Gusu School,Nanjing Medical University,Suzhou 215000,China)

机构地区：[1]内江市第一人民医院超声医学科,641000 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院体外循环中心,100037 [3]北京大学国际医院心外科,102206 [4]成都中科奥格生物科技有限公司,610094 [5]广元市第一人民医院胸心外科,628000 [6]南京医科大学姑苏学院附属苏州医院心血管病中心,苏州215000 [7]电子科技大学附属医院,四川省医学科学院·四川省人民医院,临床免疫转化医学四川省重点实验室,成都610072 [8]南京医科大学姑苏学院附属苏州医院心血管外科,苏州215000

出　　处：《中华医学超声杂志（电子版）》2024年第6期617-623,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：苏州市姑苏卫生人才计划(GSW2022065);苏州市临床重点病种诊疗技术专项项目(LCZX202211);南京医科大学姑苏学院引进人才项目(GSRCKY20210101)。

摘　　要：目的:探讨超声在基因编辑猪-猴异种并联式心脏移植术中的应用价值。方法:2023年12月于四川省医学科学院·四川省人民医院实验动物研究所实施一例基因编辑猪-猴异种心脏移植,利用超声评估术前心脏大小与功能,辅助移植方案的制定,术后监测心脏功能和结构变化、吻合口血流及全身一般情况等。采用Spearman相关分析猪心左心室内膜(LVEN)厚度、猪心右心室内膜(RVEN)厚度与IgG、IgM抗体的相关性。结果:术前评估显示供受体心脏大小及功能的超声测量参数差距较大,供受体匹配良好,提示心脏异位并联式移植术具有可行性。术后猪心与猴心在并联状态下协同工作,共同维持猴的血液循环,且吻合口通畅,术后猴心射血分数始终维持在60%左右,猪心射血分数维持在35%左右。术后猪心二尖瓣前乳头肌、猪心左右心室壁逐渐增厚(二尖瓣前乳头肌厚度5.4~8.8 mm,左心室壁厚度6.0~8.5 mm,右心室壁厚度2.1~3.5 mm),术后猪心左、右心室心内膜逐渐增厚(LVEN 1.0~3.1 mm,RVEN 1.0~2.8 mm)。术后免疫指标IgG、IgM值未见升高。相关性分析显示,IgG、IgM与左、右心室心内膜厚度均无显著的相关性(P均>0.05)。结论:基因编辑猪作为异种移植供体具有可行性。超声对于异种并联式心脏移植术的术前评估、手术效果评价、术后管理和免疫监测具有良好的应用价值,可为未来临床应用提供有力的技术支持和数据参考。ObjectiveTo assess the application value of ultrasound in gene edited pig-monkey xenogeneic heart transplantation.MethodsOn December 16, 2023, a case of gene-edited pig-monkey heart xenotransplantation was performed in the Institute of Experimental Animals of Sichuan Academy of Medical Sciences and Sichuan People's Hospital. Ultrasound was used to evaluate the size and function of the heart before surgery to assist in the formulation of the transplantation plan, and to monitor the changes of cardiac function and structure, anastomotic blood flow, and general conditions of the whole body after surgery. Spearman correlation was used to analyze the correlation of the thickness of pig heart left ventricular intima (LVEN) and the thickness of pig heart right ventricular intima (RVEN) with IgG and IgM antibodies.ResultsThe preoperative evaluation showed that the size and function of donor and recipient hearts were different and the donor and recipient were well matched, suggesting the feasibility of heterotopic cardiac transplantation. After operation, the pig heart and the monkey heart worked together in parallel to maintain the blood circulation of the monkey, and the anastomosis was smooth. The ejection fraction of the monkey heart and the pig heart were maintained at about 60% and 35%, respectively. After operation, the anterior papillary muscle of the mitral valve and the wall of the left and right ventricles of the pig heart gradually thickened (the thickness of the anterior papillary muscle of the mitral valve was 5.4 ~ 8.8 mm, the thickness of the left ventricular wall was 6.0 ~ 8.5 mm, and the thickness of the right ventricular wall was 2.1 ~ 3.5mm), and the ventricular intima of the pig heart also thickened (LVEN: 1.0 ~ 3.1 mm, RVEN: 1.0 ~ 2.8 mm). There was no increase in IgG or IgM antibodies after operation. Correlation analysis showed that there was no significant correlation between IgG/IgM antibodies and the endocardial thickness of the left and right ventricles (P > 0.05).Conclusion

关 键 词：基因编辑猪 恒河猴 超声心动图 异种心脏移植 

分 类 号：R445.1[医药卫生—影像医学与核医学] R54[医药卫生—诊断学]