双核素单光子断层显像评价骨髓单个核细胞移植后急性心肌梗死患者存活心肌变化

Evaluation of myocardial viability with 201)Tl/^(18)F-FDG DISA-SPECT technique in patients with acute myocardial infarction after emergent intracoronary autologous bone marrow mononuclear cells transplantation

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 myocardial viability with ^201 Tl/ ISF-FDG DISA-SPECT technique in patients with acute myocardial infarction underwent emergent intracoronary autologous bone marrow mononuclear cells （BM-MNC） transplantation. Methods Patients with first acute myocardial infarction underwent emergent percutaneous coronary intervention （PCI） were randomized in a 1：1 ratio to either intracoronary transplantation of autologous BM-MNC （n = 20） or to sodium chloride concluding heparin （control, n =20） via a micro infusion catheter group immediately after PCI. Change in global left ventricttlar function （LVEF measured by echocardiography ） and the myocardial viability detected by ^201 Tl/^18 F-FDG DISA-SPECT from baseline and 6-months post transplantation were analyzed. Results Left ventricular ejection fraction （LVEF） was improved in both groups and the absolute increase （ ALVEF ） in BM-MNC group was significantly higher than that in control group （7.6% ±2. 8% vs. 3.0% ±2. 8% ,P 〈 0. 001 ）. In addition, the absolute decrease of myocardial infusion defect detected by ^201 Tl SPECT was more significant in BM-MNC group than that in control group （6. 7% ±3.0% vs. 2.6% ±2.6% ,P 〈0. 001） and the number of mismatched segments （indicating viable myocardium） detected by ^18 F-FDG SPECT in border zone was also significantly higher in BM-MNC group than that in control group. Conclusion Improved myocardial viability and reduced myocardial infusion defect post emergent intracoronary transplantation of autologous BM-MNC in patients with acute myocardial infarction could be detected by ^201 Tl/ is F-FDG DISA-SPECT technique.