单光子放射计算机断层显像术对自体骨髓单个核细胞移植治疗缺血性心脏病的评价

SPECT evaluation on therapy of autologous bone marrow mononuclear cell transfer for coronary artery disease

目的探讨经皮冠状动脉内移植自体骨髓干细胞治疗缺血性心脏病的可行性和定量核素心肌显像对其临床疗效的评价。方法入选经冠状动脉造影确诊的冠心病患者82例,分为骨髓细胞移植组(49例)和对照组(33例)。骨髓细胞移植组除常规治疗外,将骨髓单个核细胞悬液经造影导管注入冠状动脉内。对照组仅采用常规治疗。用经胸超声心动图和单光子放射计算机断层显像术(SPECT)比较两组治疗前、后超声指标和心肌灌注缺损区面积。结果术后随访1年,经胸超声心动图显示,移植组术前、术后左室射血分数由(43.3±5.5)%增加到(54.1±4.3)%,与对照组相比差异有统计学意义。SPECT显示,移植组和对照组心肌灌注缺损面积分别由(25.3±8.3)%、(26.1±6.5)%降低至(14.7±4.6)%、(20.2±7.1)%,前者比后者降低更明显,差异有统计学意义。移植组在移植术中和术后均无并发症发生。结论经皮冠状动脉内移植骨髓干细胞治疗缺血性心脏病安全可行,术后能改善左室收缩功能及心肌血流灌注。SPECT对干细胞移植的有效率评价有较高的临床价值。

Objective To evaluate the efficacy of intracoronary autologous bone marrow mononuclear cell transfer on coronary artery disease using quantitative myocardial imaging with nuclear isotope. Methods 82 patients of coronary artery autologous bone marrow mononuclear cell suspension or not respectively, in addition to regular treatment. The left vetricular ejection fractions and the sizes of myocardial perfusion defect were measured and compared with the use of single-photon-emission computed tomography（SPECT） and echocardiography prior to and after the treatment. Results The one year follow-up results showed that LVEF increased from base-line 43.3±5.5%to 54.1±4.3% on echocardiography in cell transfer group. The size of myocardial perfusion defect decreased from base-line （25.3±8.3）%, （26.1±6.5）% to （14.7±4.6）%, （20.2±7.1）% in cell therapy group and control respectively, the absolute change was statistically significant. During and after the procedure of cell delivery there were no complication occuring. Conclusion Percutaneous transcoronary transplantation of autologous bone marrow stem cells for treating coronary artery disease resulted in improvement in left ventricular systolic function and myocardial perfusion, and this therapy is safe and feasible.