应变和应变率成像评价自体外周血干细胞移植术后心肌梗死患者左室收缩功能变化

Quantitative Analysis of Left Ventricular Systolic Function by Strain and Strain Rate Imaging after Transplantation of Autologous Peripheral Blood Stem Cells in Patients with Myocardial Infarction

目的探讨应变(SI)及应变率成像(SRI)技术在急性心肌梗死(AMI)患者自体外周血干细胞移植治疗前后左室局部心肌功能定量评价中的应用价值。方法65例AMI患者入选本项前瞻性、非随机、开放试验,其中35例患者为细胞移植组,30例为常规治疗组,应用SRI、SI和TVI测定细胞移植组,常规治疗组治疗前后及30例正常人的左室壁各节段的SI、SRI及TVI的参数变化。结果(1)例急性心肌梗死患者的589个缺血节段的心肌收缩期峰值应变率(PSSR)、舒张早期峰值应变率(PESR)、收缩期峰值应变(PSS),心肌收缩期峰值速度(Vs)和舒张早期峰值速度(Ve)显著降低,舒张晚期峰值应变率(PASR)和舒张晚期峰值速度(Va)变化无统计学差异。SRI和SI检出缺血心肌的敏感性,特异性及准确性明显高于TVI([90%、91%、92%)比(71%、69%、71%)](P<0.01)。(2)细胞移植组随访期305个经治疗缺血心肌节段中,244个节段的PSSR、PESR、PSS、Vs及Ve较术前显著增高或恢复正常,常规治疗组随访期284个经治疗缺血节段中,169个节段的PSSR、PESR、PSS、Vs及Ve较术前显著增高或恢复正常,但两组治疗后改善的缺血心肌节段数比例及SRI、TVI参数比较有统计学差异(P<0.01)。结论SRI和SI能够无创定量评价冠心病缺血心肌节段的运动异常,为临床客观评价冠脉内自体干细胞移植术疗效提供了一种早期无创、敏感、有效的定量分析手段。

Objective To investigate the clinical value of the left ventricular regional systolic function by strain（SI ） and strain rate imaging （SRI） after transplantation of autologous peripheral blood stem cells in patients with mycardial infarction. Methods 65 patients with AMI were enrolled in this prospective open labeled study（35 patients in cell（transplantation） group;30 patients in control group. All patients were treated by standard drug therapy and percutaneous coronary intervention（PCI）,30 normal control subjects were enrolled this study,SI,SRI and TVI parameters were obtained in the two groups before and after transplantation in 6 months. Results （ 1 ）Among 589 ischemic segments of 65 patients with AMI, SRI and TVI parameters were significantly lower than those of normal control group. The sensitivity, specificity and accuracy of SI and SRI for detection of ischemic segments were significantly higher than those of TVI[（90%, 91%, 89% ）VS（71%, 69%, 71% ） P〈 0.01]. （2）PSSR, PESR, PSS, Vs and Ve of 244/305 ischemic myocardial segments showed significantly increase at 6 month and after transplantation of autologous peripheral blood stem cells, PSSP,PESR, PSS,Vs and Ve of 169/284 ischemic myocarolial segments showed significant increase at 6 months after PCI. Those parameters has statistical difference between the two groups（P〈 0.01 ）. Conclusion SI and SRI is a valid and sensitive method for detecting the regional myocardium function after transplantation of stem cells in patients with myocardial infarction.