中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (33): 5332-5338.doi: 10.3969/j.issn.2095-4344.2017.33.014

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

联合显像在冠脉搭桥联合干细胞移植治疗心肌梗死疗效评估中的价值

陆国秀1，郝珊瑚1，王治国1，张 彤1，王辉山2，张国旭1   

  1. 解放军沈阳军区总医院，1核医学科，2心外科，辽宁省沈阳市 110016
  • 修回日期:2017-06-21 出版日期:2017-11-28 发布日期:2017-12-01
  • 通讯作者: 张国旭，主任医师，硕士，解放军沈阳军区总医院核医学科，辽宁省沈阳市 110016
  • 作者简介:陆国秀，女，1982年生，辽宁省朝阳县人，汉族，2012年中国医科大学毕业，硕士，主治医师，主要从事核素诊断与治疗方面的研究。
  • 基金资助:

    2012年辽宁省第一批科学技术计划(2012225019)

Multiple imaging evaluation on the therapeutic efficacy of coronary artery bypass graft combined with autologous stem cell transplantation for myocardial infarction

Lu Guo-xiu1, Hao Shan-hu1, Wang Zhi-guo1, Zhang Tong1, Wang Hui-shan2, Zhang Guo-xu1   

  1. 1Department of Nuclear Medicine, 2Department of Cardiac Surgery, the General Hospital of Shenyang Military Command, Shenyang 110016, Liaoning Province, China
  • Revised:2017-06-21 Online:2017-11-28 Published:2017-12-01
  • Contact: Zhang Guo-xu, Master, Chief physician, Department of Nuclear Medicine, the General Hospital of Shenyang Military Command, Shenyang 110016, Liaoning Province, China
  • About author:Luo Guo-xiu, Master, Attending physician, Department of Nuclear Medicine, the General Hospital of Shenyang Military Command, Shenyang 110016, Liaoning Province, China
  • Supported by:

    the First-Batch Scientific and Technological Projects in Liaoning Province in 2012, No. 2012225019

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摘要：

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文题释义：
多模态联合影像检查：以冠状动脉血管造影、心脏彩超结合13N-NH3•H2O心肌血流灌注/18F-FDG代谢显像为评价手段，探讨冠脉搭桥术联合干细胞移植治疗前后一定时间窗内的疗效。通过定量研究血管狭窄程度、左心室功能参数、存活心肌情况、心肌功能参数等指标在治疗前后不同时间点的变化。
联合多模态显像的优势：可以从不同角度更好地评价冠脉搭桥联合干细胞移植治疗陈旧性心肌梗死的疗效。门控13N-NH3•H2O/18F-FDG PET/CT对存活心肌诊断准确性高，有利于心肌梗死患者治疗方式的选择及疗效评估；冠状动脉搭桥手术，作为冠心病治疗的有效方法，能够提高心肌梗死患者的存活率及心功能。冠脉搭桥基础上联合干细胞移植治疗有助于短期内提高患者的左心室功能；冠脉搭桥+骨髓干细胞移植与冠脉搭桥+外周血干细胞移植相比，可以有效提高存活心肌功能的恢复。

 

摘要
背景：干细胞对于陈旧性心肌梗死的治疗效果仍存在一定争议。干细胞移植治疗后多模态影像评价技术是目前研究的关键点之一，其可以从分子影像学角度评估干细胞移植疗效。
目的：影像学评估冠脉搭桥术联合不同干细胞移植治疗陈旧性心肌梗死患者的疗效。  
方法：60例陈旧性心肌梗死患者，完全随机分为3组(n=20)，分别接受单纯冠脉搭桥、冠脉搭桥+骨髓干细胞及冠脉搭桥+外周血干细胞移植治疗。治疗前，治疗后1，12，24个月依次接受心脏超声、门控13N-NH3•H2O/18F-FDG PET/CT及冠脉血管造影检查。比较受累冠脉狭窄程度、左室射血分数、13N-NH3•H2O心肌血流灌注/18F-FDG代谢异常心肌放射性分布评分值(定义为A值)及缺损面积比(定义为R值)。
结果与结论：①门控13N-NH3•H2O/18F-FDG PET/CT诊断存活心肌的灵敏度、特异度、阳性预测值及阴性预测值分别为92.1%，85.6%，93.4%及78.4%；②3组患者治疗后血管狭窄程度均较治疗前改善(P < 0.05)，以治疗后1个月效果显著(P < 0.05)；③与治疗前比较，冠脉搭桥+骨髓干细胞组、冠脉搭桥+外周血干细胞组治疗后左室射血分数升高(P < 0.05)；④冠脉搭桥+骨髓干细胞组治疗前、后不同时间点异常心肌放射性分布评分A值减低。与治疗前相比，治疗后1个月及治疗后24个月差异有显著性意义(P < 0.05)，治疗后24个月较治疗后12个月也进一步降低(P < 0.05)；⑤与治疗前相比，冠脉搭桥+骨髓干细胞组患者治疗后1个月心肌灌注/代谢缺损面积比显著降低(P=0.019)；⑥结果表明，联合多模态显像，可以从不同角度更好地评价冠脉搭桥联合干细胞移植治疗陈旧性心肌梗死的疗效。门控13N-NH3•H2O/18F-FDG PET/CT对存活心肌诊断准确性高，有利于心肌梗死患者治疗方式的选择及疗效评估；冠脉搭桥基础上联合干细胞移植治疗有助于短期内提高患者的左心室功能；与冠脉搭桥+外周血干细胞移植相比，冠脉搭桥+骨髓干细胞移植可以有效提高存活心肌功能。

 

关键词: 干细胞, 心肌梗死, 冠脉搭桥, 骨髓干细胞, 外周血干细胞, 正电子发射计算机断层显像, 冠脉血管造影

Abstract:

BACKGROUND: Stem cells are still controversial for the treatment of old myocardial infarction. Multimodal imaging evaluation is one of the key points in the study of stem cell transplantation, which can evaluate the therapeutic efficacy of stem cell transplantation from the perspective of molecular imaging.
OBJECTIVE: To evaluate the therapeutic efficacy of coronary artery bypass graft (CABG) with different stem cell transplantation in patients with old myocardial infarction using multimodal imaging technology. 
METHODS: Sixty patients with old myocardial infarction were enrolled and randomly divided into three groups to receive CABG, CABG+autologous bone marrow stem cell transplantation (CABG+BMC) or CABG+autologous peripheral blood stem cell transplantation (CABG+PBSC), respectively. All the patients were scanned with gated PET/CT (13N-NH3•H2O/18F-FDG), echocardiography and coronary angiography at different time points orderly (at baseline, 1, 12 and 24 months after treatment). We compared the degree of coronary stenosis (%), left ventricular ejection fraction (LVEF), percentage of defect size with myocardial perfusion/metabolic abnormal radioactive distribution (A) and the ratio of defect area (R). 
RESULTS AND CONCLUSION: In the diagnosis of survival myocardial segments, the sensitivity, specificity, positive predictive value and negative predictive value for the gated PET/CT were 92.1%, 85.6%, 93.4% and 78.4%, respectively. After the above treatments, the extent of coronary stenosis decreased significantly in the three groups (P < 0.05), which was improved most at 1 month after treatment (P < 0.05). In the CABG+BMC and CABG+PBSC groups, the LVEF value increased significantly after treatment (P < 0.05). In the CABG+BMC group, the A value decreased significantly at 1 and 24 months after treatment as compared with the baseline (P < 0.05), and the A value was further decreased, indicating a significant difference at 12 and 24 months after treatment (P < 0.05). In the CABG+BMC group, the R value significantly decreased at 1 month after treatment compared with the baseline (P=0.019). To conclude, the multimodal imaging is better to evaluate the prognosis of patients undergoing CABG with different stem cell transplantation, which is beneficial for the selection of treatment and therapeutic evaluation in myocardial infarction patients. CABG combined with stem cell transplantation can improve the left ventricular function of patients in a short time, and CABG+BMC is superior to CABG+PBSC to improve the survived myocardial function in patients. 

 

Key words: Myocardial Infarction, Myocardial Revascularization, Peripheral Blood Stem Cell Transplantation, Myeloid Progenitor Cells, Positron-Emission Tomography, Tissue Engineering

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