中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (1): 51-54.doi: 10.3969/j.issn.1673-8225.2011. 01.011

• 干细胞移植 stem cell transplantation • 上一篇    下一篇

心肌声学造影评价自体骨髓单个核细胞移植急性心肌梗死后的心肌再灌注：与核素心肌灌注成像比较

钱大钧，刘  欢，周达琼，吴鹏西，羊镇宇，吴小庆，王  强   

  1. 南京医科大学附属无锡人民医院心功能科，江苏省无锡市  214023
  • 收稿日期:2010-09-10 修回日期:2010-11-28 出版日期:2011-01-01 发布日期:2011-01-01
  • 作者简介:钱大钧，男，1976年生，江苏省无锡市人，汉族，1998年南京医科大学毕业，主治医师，科副主任，主要从事心脏超声研究。 qiandajun@sina.com

Assessment for the reperfusion with sonoVue intravenous myocardial contrast echocardiography in patients with acute myocardial infarction undergoing intracoronary autologous bone marrow mononuclear cells transplantation: Compared with myocardial perfusion tomographic imaging 

Qian Da-jun, Liu Huan, Zhou Da-qiong, Wu Peng-xi, Yang Zhen-yu, Wu Xiao-qing, Wang Qiang   

  1. Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi  214023, Jiangsu Province, China
  • Received:2010-09-10 Revised:2010-11-28 Online:2011-01-01 Published:2011-01-01
  • About author:Qian Da-jun, Attending physician, Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, Jiangsu Province, China qiandajun@sina.com

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摘要：

背景：以往对干细胞移植治疗急性心肌梗死后心肌再灌注的评价主要采用核素显像、MRI显像等，但这类方法重复性较差，并具有放射性。
目的：分析经静脉心肌声学造影对急性心肌梗死行自体骨髓单个核细胞移植后心肌再灌注的评价。
方法：对24例急性心肌梗死患者于单个核细胞移植前后行经静脉心肌声学造影检查，测量平台期的心肌显像增大强度A、曲线上升平均斜率β及A与β之积在移植前后的变化，并与心肌核素显像随访结果相对照，判定心肌再灌注情况。
结果与结论：经静脉心肌声学造影显示，患者移植后相关心肌节段的A、β及A•β之积均较移植前显著增加(P < 0.01)，其中血管开通后β值的变化幅度最大，随访6个月后A值变化幅度增大，说明血管开通即刻先有灌注速度加快，移植后6个月心肌灌注缺损明显改善。移植后6个月梗死区即刻和延迟相心肌核素摄取均较移植前增强，SPECT心肌灌注图像评分较移植前显著下降(P < 0.05)。说明经静脉心肌声学造影结果与核素心肌灌注显像基本一致，可床旁无创评估移植心肌细胞微循环灌注情况。

关键词: 心肌声学造影, 骨髓干细胞, 急性心肌梗死, 自体, 移植, 再灌注

Abstract:

BACKGROUND: Myocardial perfusion tomographic imaging and magnetic resonance imaging were commonly used to evaluate myocardial reperfusion following stem cell transplantation for treatment of acute myocardial infarction (AMI). However, the repetitiveness of this method is poor, and has radioactivity.
OBJECTIVE: To estimate the reperfusion of intravenous myocardial contrast echocardiography (IMCE) in patients with AMI using intravenously infused SonoVue before and after intracoronary autologous bone marrow mononuclear cells transplantation.
METHODS: IMCE was performed in 24 AMI patients before and after intracoronary autologous bone marrow mononuclear cell transplantation. The maximal amplitude score (A), the mean ascending slope of the curve (β) and the product of A×β were measured, and compared with results from myocardial perfusion tomographic imaging. Myocardial reperfusion was assessed.
RESULTS AND CONCLUSION: IMCE results exhibited that A, β and A×β were significantly increased following transplantation (P < 0.01). The changes in β value were maximal following vessel unobstruction, and change range of A value was increased following 6-month follow-up. These indicated that perfusion speed was accelerated immediately following vessel unobstruction. Myocardial perfusion defect was obviously improved at 6 months following transplantation. Myocardial nuclide intake was enhanced immediately and at lag phase in the infarct region at 6 months following transplantation, and the score of single photon emission computed tomography imaging was significantly diminished (P < 0.05). These indicated that results of IMCE are basically identical to that of myocardial perfusion tomographic imaging, and IMCE can noninvasively assess microcirculation perfusion of transplanted myocardial cells.

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