本文選題：光聲成像技術(shù) + 急性心肌缺血��； 參考：《福建醫(yī)科大學(xué)》2015年博士論文

【摘要】：研究背景和目的:心肌缺血和再灌注在心血管疾病發(fā)展過程中至關(guān)重要。目前評估心肌血流灌注的檢查方法各有優(yōu)缺點(diǎn),但都不能完全滿足臨床需求。光聲成像技術(shù)(photoacoustic imaging technology,PAT)結(jié)合光學(xué)和超聲的優(yōu)點(diǎn),具有分辨率高、對比度高、成像深度深等特點(diǎn),并且沒有輻射危害。本次研究在原有基礎(chǔ)上,以新西蘭白兔為實(shí)驗(yàn)對象,分別建立急性心肌缺血、急性心肌缺血再灌注和慢性心肌缺血三種動(dòng)物模型。采用成像速度更快、分辨率更高的PAT系統(tǒng),以血紅蛋白作為天然“造影劑”,在兔活體心臟上面進(jìn)行PAT三維成像,探討其評估心肌缺血和再灌注的可行性。1.急性心肌缺血光聲成像方法將42只新西蘭白兔(2.78±0.23Kg)隨機(jī)分成兩組:急性缺血組直接結(jié)扎左旋支建立急性心肌缺血模型,分別建立結(jié)扎0.5h、1h、2h、3h、4h、6h模型,每個(gè)時(shí)間點(diǎn)6只;另6只僅穿線不打結(jié),建立假手術(shù)6h為對照組。分別在不同時(shí)間點(diǎn)描記心電圖;采血檢測血清心肌損傷標(biāo)志物(c Tn I、CK-MB);并在缺血區(qū)域進(jìn)行PAT成像,計(jì)算灰度值和總量。實(shí)驗(yàn)后取心臟行HE染色、TUNEL凋亡檢測,計(jì)算病理學(xué)指標(biāo)(半定量評分SAS、細(xì)胞凋亡指數(shù)AI)。結(jié)果急性缺血組血清心肌損傷標(biāo)志物、病理學(xué)指標(biāo)均隨結(jié)扎時(shí)間的延長呈增高趨勢(P0.05),而結(jié)扎6h組AI值比結(jié)扎4h組小(P0.05)。PAT指標(biāo)(灰度值、總量)均隨結(jié)扎時(shí)間的延長呈下降趨勢(P0.05)。PAT指標(biāo)與血清心肌損傷標(biāo)志物、病理學(xué)指標(biāo)呈負(fù)相關(guān)(P0.05)。結(jié)論急性心肌缺血6h內(nèi),心肌缺血損傷隨時(shí)間延長而加重;灰度值、總量隨時(shí)間增加而降低。PAT可以用于評估急性心肌缺血程度和范圍,灰度值、總量均與心肌缺血損傷呈反比。2.急性心肌缺血再灌注光聲成像方法將24只新西蘭白兔(2.77±0.24Kg)分為再灌注組,以結(jié)扎左旋支2h后開放建立急性心肌缺血再灌注模型:隨機(jī)分成4個(gè)小組,每個(gè)小組6只,分別建立開放0.5h、1h、2h、4h再灌注模型。分別在不同時(shí)間點(diǎn)描記心電圖;采血檢測血清心肌損傷標(biāo)志物;并在缺血區(qū)域進(jìn)行PAT成像,計(jì)算灰度值和總量。實(shí)驗(yàn)后取心臟行HE染色、TUNEL凋亡檢測等組織病理學(xué),并技術(shù)病理學(xué)指標(biāo)。并分別與急性缺血組結(jié)扎3h、4h、6h等相應(yīng)時(shí)間進(jìn)行比較。取結(jié)扎2h組、假手術(shù)6h組作為對照組。結(jié)果再灌注組血清心肌損傷標(biāo)志物及病理學(xué)指標(biāo)隨開放時(shí)間增加呈增高趨勢(P0.05),除了開放4h組AI值小于開放2h組(P0.05)。但開放4h組血清心肌損傷標(biāo)志物及SAS均比結(jié)扎6h組低(P0.05);而開放4h組AI比結(jié)扎6h高(P0.05)�；叶戎岛涂偭烤S開放時(shí)間延長呈增高趨勢(P0.05)。而開放4h組灰度值與對照組比較無差異(P0.05),開放4h組總量較對照組低(P0.05)。PAT指標(biāo)與血清心肌損傷標(biāo)志物、病理學(xué)指標(biāo)呈正相關(guān)(P0.05)。結(jié)論結(jié)扎2h再灌注4h內(nèi),隨再灌注時(shí)間增加,心肌損傷加重,但是加重的幅度小于急性缺血組;PAT灰度值和總量與心肌損傷呈正比;開放4h組總量沒有恢復(fù)到對照組水平,可能與無復(fù)流現(xiàn)象有關(guān)。PAT可以用于評估急性心肌缺血再灌注程度和范圍。3.慢性心肌缺血光聲成像方法將13只新西蘭白兔(2.60±0.20Kg)隨機(jī)分成兩組,實(shí)驗(yàn)組取10只在左旋支安置Ameroid縮窄器,建立慢性心肌缺血模型;對照組取3只,只開胸,不放置Ameroid縮窄器。建模后第5周采血檢測心肌損傷標(biāo)志物;并經(jīng)右頸動(dòng)脈行冠狀動(dòng)脈造影檢查,根據(jù)TIMI血流分級,實(shí)驗(yàn)組將TIMI分級2~3級設(shè)為慢性缺血組,TIMI分級0~1級設(shè)為梗死組;再次開胸在缺血區(qū)域進(jìn)行PAT成像,計(jì)算灰度值和總量。成像后取心臟行HE染色。結(jié)果成功建立梗死組4只,慢性缺血組3只。梗死組血清心肌損傷標(biāo)志物高于慢性缺血組和對照組(P0.05)。PAT總量與TIMI血流分級具有很高的等級相關(guān)性(r:0.849;P0.05)。結(jié)論Ameroid縮窄器可以用于建立慢性心肌缺血兔動(dòng)物模型。而PAT對于慢性心肌缺血的評估,具有很好的應(yīng)用價(jià)值�？偨Y(jié):應(yīng)用PAT檢測心肌缺血和再灌注具有很大的潛力。雖然當(dāng)前研究尚有許多不足,但是隨著技術(shù)的改進(jìn),PAT將在未來臨床應(yīng)用中發(fā)揮自己的特色。
[Abstract]:Background and objective: myocardial ischemia and reperfusion is very important in the development of cardiovascular disease. There are advantages and disadvantages in the assessment of myocardial perfusion, but they are not fully satisfied with the clinical requirements. Photoacoustic imaging technology (PAT) combines the advantages of optical and ultrasound with high resolution. In this study, three animal models of acute myocardial ischemia, acute myocardial ischemia reperfusion and chronic myocardial ischemia were established on the basis of New Zealand white rabbits on the original basis. The PAT system with faster imaging speed and higher resolution was used as the hemoglobin. Natural "contrast agent", PAT three-dimensional imaging on the rabbit's living heart was performed to evaluate the feasibility of evaluating myocardial ischemia and reperfusion..1. acute myocardial ischemia photoacoustic imaging method was randomly divided into two groups of 42 New Zealand white rabbits (2.78 + 0.23Kg): acute ischemia group directly ligated left circumflex to establish acute myocardial ischemia model and set up ligation respectively. 0.5h, 1H, 2h, 3h, 4h, 6h model, 6 only at each time point; the other 6 only thread without knot and set up the false operation 6h as the control group. The electrocardiogram was traced at different time points, the serum myocardial damage markers (C Tn I, CK-MB) were detected by blood sampling, and the PAT imaging was carried out in the ischemic region. Test and calculate the pathological indexes (semi quantitative score SAS, apoptosis index AI). Results the serum myocardial damage markers in the acute ischemic group increased with the prolongation of the ligation time (P0.05), while the AI value of the ligation group was lower than the ligation 4H group (P0.05).PAT index (gray value, total amount) decreased with the prolongation of ligation time (P0.0) (P0.0). 5).PAT index was negatively correlated with serum myocardial damage markers and pathological indexes (P0.05). Conclusion myocardial ischemia injury increased with time in 6h of acute myocardial ischemia, and the gray value, the total amount of.PAT decreased with time, could be used to evaluate the extent and extent of acute myocardial ischemia, and the gray value and total amount were in inverse proportion to myocardial ischemia injury,.2. The acute myocardial ischemia reperfusion photoacoustic imaging method divided 24 New Zealand white rabbits (2.77 0.24Kg) into reperfusion group. After ligating the left circumflex 2h, the model of acute myocardial ischemia reperfusion was set up. The models were randomly divided into 4 groups, each group was 6, and the open 0.5h, 1H, 2h, 4H reperfusion model were set up respectively. Serum myocardial damage markers were detected by blood sampling, and PAT imaging was performed in the ischemic region to calculate the gray value and total amount. After the experiment, the heart was stained with HE, TUNEL apoptosis detection and histopathology, and the technical pathological indexes were compared with those of the acute ischemia group, which were ligated to 3h, 4h, 6h and so on. The 2H group was ligated and the sham operation 6h group was taken as the pair. Results the serum myocardial damage markers and pathological indexes increased with the opening time (P0.05), except that the AI value of the open 4H group was less than the open 2H group (P0.05), but the serum myocardial damage markers and SAS in the open 4H group were lower than those of the ligation group (P0.05), while the AI 4H group AI was higher than the ligation of the 6h group. The opening time was increased (P0.05), but there was no difference between the open 4H group and the control group (P0.05), the total amount of the open 4H group was lower than the control group (P0.05).PAT index and the serum myocardial damage markers, and the pathological indexes were positively correlated (P0.05). Conclusion the myocardial injury aggravated with the increase of reperfusion time, but the aggravation of the myocardial injury was aggravated, but the aggravation of the myocardial injury was aggravated. The amplitude was less than that in the acute ischemic group; the PAT gray value and total amount were proportional to the myocardial injury; the total amount of the open 4H group did not recover to the control level. It may be related to the non reflux phenomenon that.PAT could be used to evaluate the degree of acute myocardial ischemia and reperfusion and the range of.3. chronic myocardial ischemia by the 13 New Zealand white rabbits (2.60 + 0.20Kg). The experimental group was divided into two groups. In the experimental group, 10 left circumflex Ameroid coarctation apparatus were set up to establish the chronic myocardial ischemia model, and 3 rats in the control group were taken only to open the chest and do not place the Ameroid coarctation apparatus. After modeling, the blood samples were detected for Fifth weeks, and the coronary angiography was performed by the right carotid artery, and the experimental group was graded TIMI according to the TIMI blood flow classification, and the experimental group classified TIMI 2~3 class In the chronic ischemia group, the TIMI grade 0~1 grade was set as the infarction group; the PAT imaging was performed in the ischemic area again, and the gray value and the total amount were calculated. After the imaging, the heart was stained with HE. The results were successfully established in 4 infarct groups and 3 in the chronic ischemia group. The markers of serum myocardial injury in the infarction group were higher than that of the chronic ischemia group and the control group (P0.05).PAT total and TIMI. The classification of blood flow has a high level of correlation (r:0.849; P0.05). Conclusion Ameroid coarctation can be used to establish a rabbit model of chronic myocardial ischemia. And PAT has a good application value for the assessment of chronic myocardial ischemia. Conclusion: the application of PAT to detect myocardial ischemia and reperfusion has great potential. Although there are many current studies, there are many studies. Insufficient, but with the improvement of technology, PAT will play its own characteristics in the future clinical application.

【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R54

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