發(fā)布時(shí)間：2018-05-04 03:33

  本文選題：心肌梗塞 + 心肌血管重建術(shù)�。� 參考：《中國(guó)組織工程研究》2017年33期

【摘要】：背景:干細(xì)胞對(duì)于陳舊性心肌梗死的治療效果仍存在一定爭(zhēng)議。干細(xì)胞移植治療后多模態(tài)影像評(píng)價(jià)技術(shù)是目前研究的關(guān)鍵點(diǎn)之一,其可以從分子影像學(xué)角度評(píng)估干細(xì)胞移植療效。目的:影像學(xué)評(píng)估冠脈搭橋術(shù)聯(lián)合不同干細(xì)胞移植治療陳舊性心肌梗死患者的療效。方法:60例陳舊性心肌梗死患者,完全隨機(jī)分為3組(n=20),分別接受單純冠脈搭橋、冠脈搭橋+骨髓干細(xì)胞及冠脈搭橋+外周血干細(xì)胞移植治療。治療前,治療后1,12,24個(gè)月依次接受心臟超聲、門(mén)控13N-NH3·H2O/18F-FDG PET/CT及冠脈血管造影檢查。比較受累冠脈狹窄程度、左室射血分?jǐn)?shù)、13N-NH3·H2O心肌血流灌注/18F-FDG代謝異常心肌放射性分布評(píng)分值(定義為A值)及缺損面積比(定義為R值)。結(jié)果與結(jié)論:(1)門(mén)控13N-NH3·H2O/18F-FDG PET/CT診斷存活心肌的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值及陰性預(yù)測(cè)值分別為92.1%,85.6%,93.4%及78.4%;(2)3組患者治療后血管狹窄程度均較治療前改善(P0.05),以治療后1個(gè)月效果顯著(P0.05);(3)與治療前比較,冠脈搭橋+骨髓干細(xì)胞組、冠脈搭橋+外周血干細(xì)胞組治療后左室射血分?jǐn)?shù)升高(P0.05);(4)冠脈搭橋+骨髓干細(xì)胞組治療前、后不同時(shí)間點(diǎn)異常心肌放射性分布評(píng)分A值減低。與治療前相比,治療后1個(gè)月及治療后24個(gè)月差異有顯著性意義(P0.05),治療后24個(gè)月較治療后12個(gè)月也進(jìn)一步降低(P0.05);(5)與治療前相比,冠脈搭橋+骨髓干細(xì)胞組患者治療后1個(gè)月心肌灌注/代謝缺損面積比顯著降低(P=0.019);(6)結(jié)果表明,聯(lián)合多模態(tài)顯像,可以從不同角度更好地評(píng)價(jià)冠脈搭橋聯(lián)合干細(xì)胞移植治療陳舊性心肌梗死的療效。門(mén)控13N-NH3·H2O/18F-FDG PET/CT對(duì)存活心肌診斷準(zhǔn)確性高,有利于心肌梗死患者治療方式的選擇及療效評(píng)估;冠脈搭橋基礎(chǔ)上聯(lián)合干細(xì)胞移植治療有助于短期內(nèi)提高患者的左心室功能;與冠脈搭橋+外周血干細(xì)胞移植相比,冠脈搭橋+骨髓干細(xì)胞移植可以有效提高存活心肌功能。
[Abstract]:Background: the efficacy of stem cells in the treatment of old myocardial infarction remains controversial. Multi-mode image evaluation technique is one of the key points in the research of stem cell transplantation. It can evaluate the effect of stem cell transplantation from molecular imaging perspective. Objective: to evaluate the effect of coronary artery bypass grafting combined with different stem cell transplantation in the treatment of old myocardial infarction. Methods 60 cases of old myocardial infarction were randomly divided into 3 groups: coronary artery bypass graft, coronary artery bypass graft bone marrow stem cell and peripheral blood stem cell transplantation. Cardiac ultrasound, gated 13N-NH3 H2O/18F-FDG PET/CT and coronary angiography were performed before, 12 and 24 months after treatment. Compared with the degree of coronary stenosis, left ventricular ejection fraction (LVEF) and ratio of defect area (defined as R value) of myocardial radioactivity distribution (defined as A value) and defect area ratio (defined as R value) of myocardial perfusion by 18F-FDG were compared. Results and conclusion: the sensitivity and specificity of gated 13N-NH3 H2O/18F-FDG PET/CT in the diagnosis of viable myocardium. The positive predictive value and negative predictive value were 92.4% and 78.4%, respectively. The degree of vascular stenosis after treatment was significantly improved in the coronary artery bypass graft bone marrow stem cell group compared with that before treatment. The left ventricular ejection fraction (LVEF) in the coronary artery bypass graft peripheral blood stem cell group (PBSC group) was increased after treatment (P 0.05). The score A of abnormal myocardial radioactivity distribution was decreased at different time points before and after coronary artery bypass graft bone marrow stem cell group. Compared with before treatment, there was a significant difference in P0.05T between 1 month after treatment and 24 months after treatment, and there was also a further decrease in P0.05 after treatment at 24 months after treatment compared with 12 months after treatment) compared with that before treatment, there was a significant difference between the two groups before and after treatment. The ratio of myocardial perfusion to metabolic defect in patients with coronary artery bypass graft bone marrow stem cell group was significantly reduced 1 month after treatment. The results showed that the combined multimodal imaging showed that the ratio of myocardial perfusion to metabolic defect was significantly decreased in patients with coronary artery bypass graft bone marrow stem cell group. The effect of coronary artery bypass grafting combined with stem cell transplantation in the treatment of old myocardial infarction can be better evaluated from different angles. Gated 13N-NH3 H2O/18F-FDG PET/CT is of high accuracy in the diagnosis of viable myocardium, which is beneficial to the choice of treatment mode and evaluation of therapeutic effect in patients with myocardial infarction, and the combination of coronary artery bypass grafting and stem cell transplantation is helpful to improve the left ventricular function in the short term. Compared with peripheral blood stem cell transplantation, bone marrow stem cell transplantation with coronary artery bypass graft can effectively improve the function of viable myocardium.
【作者單位】： 解放軍沈陽(yáng)軍區(qū)總醫(yī)院核醫(yī)學(xué)科;解放軍沈陽(yáng)軍區(qū)總醫(yī)院心外科;
【基金】：2012年遼寧省第一批科學(xué)技術(shù)計(jì)劃(2012225019)~~
【分類(lèi)號(hào)】：R542.22

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