正电子发射计算机断层显像评估曲美他嗪对缺血性心肌病心肌代谢的影响

Effects of trimetazidine on myocardial metabolism evaluated by PET-CT in patients with ischemic cardiomyopathy

目的用正电子发射计算机断层显像（positron emission computed tomography，PET-CT）评估曲美他嗪对缺血性心脏病心肌细胞代谢的影响。方法入选30例缺血性心脏病患者，随机分为治疗组（A组）和对照组（B组），在常规治疗基础上分别接受曲美他嗪（60mg／d）和安慰剂治疗，随访12个月。治疗前、后均行心肌门控单光子发射计算机断层扫描显像（gated single photon emission computerized tomography，SPECT）、PET-CT心肌显像以及心脏彩色多普勒超声检测，选择并测定血流灌注一代谢匹配（均降低）节段的心肌标准化摄取值（SUV）。结果A组在12个月后左心室射血分数（LVEF）由（37．9±5．0）％增加至（42．3±10．4）％（P〈0．05），B组由治疗前（38．1±4．6）％增加至（40．1±5．5）％（P〈0．05）；SPECT心肌显像显示，治疗组血流-代谢匹配节段的静息评分A组从3．9±1．0降低至2．4±2．3（P〈0．01）；B组从4．0±0．7降低为2．8±1．8（P〈0．05），但两组比较差异无统计学意义。A组匹配节段心肌^18F-FDG的平均SUV由6．3±1．5增加为9．8±4．7（P〈0．05），B组平均SUV值由治疗前6．4±1．2增加至7．5±2．3（P〉0．05）。结论PET-CT心肌显像与心肌SPECT血流灌注显像相结合能够检测缺血而存活心肌，曲美他嗪能够改善缺血心肌葡萄糖摄取能力，增加心肌葡萄糖氧化代谢，改善心脏功能。

Objective Trimetazidine（TZM） has been shown to have anti-ischemia properties by optimizing ischemic myocardium metabolism. We evaluated the effect of TZM on myocardial metabolism with Positron Emission Computed Tomography （PET-CT） in patients with ischemic cardiomyopathy. Methods TZM （60 mg/d, n = 15） or placebo （n = 15） was randomly applied to ischemic cardiomyopathy patients on top of conventional therapy for 12 months. Color Doppler Flow Imaging （CDFI）, ^18SF-FDP PET-CT imaging and ^99mTc-MIBI gated single photon emission computerized tomography （SPECT） imaging were performed at study begin and after 12 months. LVEF with CDFI, summed rest scores （SRS） with SPECT and standard uptake value （SUV） with PET-CT of the segments which were perfusion-metabolism matched and decreased were determined respectively. Results After 12months, LVEF of the therapy group was increased from （ 37.9 ± 5.0） % to （42. 3 ± 10. 4） % （ P 〈 0. 05 ）, while the control group increased from （37. 9 ± 4. 6） % to （40.1 ±5.5）% （ P 〉0. 05） ; SRSs of the matched segments of the therapy and the control were reduced from3.9±1.0 to 2.4±2.3 （P〈0.01） and 4.0±0.7 to 2.8±1.8（P〈0.05） respectively, while LVEF and SRSs were similar at study begin and after 12 months between these two groups. SUV of myocardial segments classified as myocardial perfusion-metabolism matched was increased from 5.3 ± 1.5 to 9.8 ± 4.7 in the therapy group （P 〈 0. 05 ） and from 5.4 ± 1.2 to 6. 0 ± 2. 3 （ P 〉 0. 05 ） in the placebo group, SUV was significantly higher in the therapy group than that in placebo group after 12 months （ P 〈 0. 05 ）. Conclusion SPECT and ^18F-FDG imaging combination could be used to detect the surviving myocardium and chronic trimetazidine treatment could increase the glucose metabolism of ischemic cardiomyocytes in patients with ischemic cardiomyopathy.