多巴酚丁胺负荷超声背向散射积分评价基因转染治疗慢性心肌缺血的价值  

Evaluation of chronic ischemic myocardium before and after gene transfer by combination of ultrasonic integrated backscatter and dobutamine stress test

作　　者：徐静[1] 赵宝珍[1] 顾俊彦[2] 王忠[3] 赵旭升[1] 陆世萍[1] 刘明[2] 王云东[1] 

机构地区：[1]第二军医大学长海医院超声科,上海200433 [2]第二军医大学长海医院胸心外科,上海200433 [3]第二军医大学长海医院麻醉科,上海200433

出　　处：《中华超声影像学杂志》2004年第1期52-55,共4页Chinese Journal of Ultrasonography

摘　　要：目的　探讨超声背向散射积分 (IBS)技术结合多巴酚丁胺负荷实验检测基因转染慢性缺血心肌治疗的价值。方法　在猪冠状动脉左旋支放置Ameroid环建立慢性心肌缺血模型 ;4周后分组注射携带血管内皮生长因子 B基因的重组腺病毒液或磷酸盐缓冲液 ;再 4周后取心肌组织进行病理学检查。应用背向散射积分技术观测正常、置环后 2周、4周及注射后 2周、4周基础状态和 10 μg·kg-1·min-1多巴酚丁胺负荷时左心室侧后壁标化平均背向散射积分 (%AII)、IBS周期变化幅度 (CVIB)及CVIB跨壁梯度 (TGI)的变化。结果　负荷时对照组正常、置环后 2周和 4周CVIB较基础状态明显增加 (P <0 .0 1～P <0 .0 5 ) ,而注射后 2周和 4周较基础状态无明显差异 (P >0 .0 5 )。正常心肌负荷时心内膜下CVIB的增加大于心外膜下 ,TGI明显增加 (P <0 .0 1)。置环后 2周负荷时TGI亦较基础状态增加 (P <0 .0 5 ) ,以后各阶段多巴酚丁胺对TGI无显著影响 ;基因转染组注射前负荷CVIB的变化同对照组。注射后 2周负荷CVIB和TGI较基础状态略有增加 ,但均差异无显著性意义。注射后 4周负荷CVIB较基础状态有显著增加 ,心内膜下CVIB的增加大于心外膜下 ,TGI明显大于基础状态 (P <0 .0 5 )。%AII均无明显变化。结论　IBS和多巴酚丁胺负荷实验相结合 。Objective To investigate integrated backscatter (IBS) combining with dobutamine stress in detecting chronic ischemic myocardium before and after gene transfer.Methods An Ameroid constrictor was placed around the left circumflex artery of each open chest pig.After 4 weeks,groupⅠandⅡwere intramyocardially injected recombinant adenovirus coding for the vascular endothelial growth factors or phosptat buffer.After another 4 weeks,pathological investigation of their hearts were performed.The calibrated average image intensity (%AII),cyclic variation of integrated backscatter (CVIB) and the subendo epicardical gradient index (TGI) of lateral posterior wall in basic or 10 μg·kg -1 ·min -1 dobutamine stress state at normal state,2 weeks and 4 weeks after Ameroid placement,2 weeks and 4 weeks after injection were measured.Results During dobutamine stress,CVIB of control group at normal state and 2 weeks,4 weeks after placing Ameroid increased significantly(P< 0.01 to P< 0.05 ) and increased at 2 weeks and 4 weeks after injection insignificantly (P> 0.05 ).The TGI increased significantly in normal state and at 2 weeks (P< 0.01 and P< 0.05 ).The changes of CVIB of gene transfer group before injection were the same as that of the control group.Two weeks after gene transfer during stress,the transmural,subepicardial and subendocardical CVIB increased insignificantly,but at 4 weeks the transmural CVIB and TGI increased significantly (P< 0.01 ). %AII in two groups changed insignificantly.Conclusions IBS combining with dobutamine stress test can early,rapidly detect myocardium structure and wall motion changes of chronic ischemic myocardium before and after gene transfer,judge the injury degree in different layer,and provide more help to clinical treatment of coronary disease.

关 键 词：超声背向散射积分 基因转染 治疗 慢性心肌缺血 多巴酚丁胺负荷实验 动物模型 

分 类 号：R542.2[医药卫生—心血管疾病]