论文部分内容阅读
目的利用双核素[~(201)铊(Tl)及~(18)F-脱氧葡萄糖(FDG)]单光子断层显像(SPECT)方法评价经冠状动脉自体骨髓单个核细胞(BM-MNC)移植对急性心肌梗死患者心功能和存活心肌的影响。方法 40例首次 ST 段抬高急性心肌梗死患者,成功完成 PCI 术后,随机分为细胞移植组(n=20)和对照组(n=20),急诊冠状动脉造影术同时,经微导管于梗死相关动脉内支架远端注入自体BM-MNC 悬液或等量的肝素生理盐水。研究终点为 PCI 术后6个月时双核素(~(201)Tl 及~(18)F-FDG)SPECT 测定存活心肌的变化。结果随访6个月时,两组患者左心室射血分数均有显著提高,但移植组患者左室射血分数改善幅度更显著[(7.6±2.8)%比(3.0±2.8)%,P<0.001]。~(201)Tl-SPECT 显示移植组患者左心室心肌灌注明显改善,心肌灌注缺损面积减少(6.7±3.0)%,同时~(18)F-FDG-SPECT结果显示梗死边缘区心肌灌注-代谢不匹配面积明显增加,提示存活心肌明显增加。结论自体 BM-MNC 可以改善急性心肌梗死后梗死边缘区心肌灌注,增加局部存活心肌,提高左心室功能。
OBJECTIVE: To evaluate the efficacy and safety of transcatheter arterial bone marrow mononuclear cells (BM-MNC) transplantation using dual-nuclide [~ (201) thallium (Tl) and [~ 18] F-deoxyglucose (FDG)] single photon tomography (SPECT) Effect on cardiac function and viable myocardium in patients with acute myocardial infarction. Methods Forty patients with acute myocardial infarction (ST-elevation) were enrolled in this study. After successful PCI, they were randomly divided into two groups: the cell transplantation group (n = 20) and the control group (n = 20) Infarction-related artery stent implantation of autologous BM-MNC suspension or equal amount of heparin saline. The end point of the study was the changes in viable myocardium measured by dual nuclear (~ (201) Tl and ~ (18) F-FDG) SPECT at 6 months after PCI. Results After six months of follow-up, left ventricular ejection fraction increased significantly in both groups, but the improvement rate of left ventricular ejection fraction was more significant in the transplantation group (7.6 ± 2.8% vs 3.0 ± 2.8%, P < 0.001]. ~ (201) Tl-SPECT showed that left ventricular myocardial perfusion was significantly improved and the area of myocardial perfusion defect was decreased by 6.7 ± 3.0% in the transplantation group, while the myocardial perfusion-metabolism in the marginal zone of infarction was not observed by 18 F-FDG- Matching area increased significantly, suggesting a significant increase in viable myocardium. Conclusion Autologous BM-MNC can improve myocardium perfusion in infarct border area after acute myocardial infarction, increase local viable myocardium and improve left ventricular function.