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局部心肌功能的临床研究

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)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。方法共有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和多普勒速度成像(TVI)测定细胞移植组、常规治疗组治疗前、后及30名健康人的左室壁各节段的SI、SRI及TVI的参数变化。结果①65例AMI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)变化差异无统计学意义。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参数比较差异有统计学意义(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 straim （SI）and strain rate imaging （SRI）after transplantation of autologous peripheral blood stem ceils in patients with myeardial 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 pereutaneous coronary intervention （PCI）, 30 noromary 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 Among 589 ischemic segments of 65 patients with AMI,SRI and TVI parameters were significantly lower than those of noromary control group.the sensitivity,specificity and accuracy of SI and SRI for detection of isehemie segments were significantly higher than those of TVI [（90%,91%,89%）vs （71%,69%,71%）,P〈0.01]. PSSR,PESR,PSS,Vs and Ve of 244/305 isehemie myocardial segments showed significant increase at 6 month after transplantation of autologous peripheral blood stem cells. PSSP,PESR,PSS,Vs and Ve of 169/284 isehemie myoearolial segments showed significant increase at 6 months after PCI. Those parameters has statistics difference the two groups （P〈 0.01 ）. Conelusion SI and SRI is a valid and sensitive method for detecting the regional rnyoeardium function after transplantation of stem cells in patients with myocardial infarction.