静态心肌灌注-代谢显像评价心肌梗死后经冠状动脉介入骨髓干细胞移植治疗的价值

Myocardial imaging of 18F-FDG and 99mTc-sestamibi on SPECT for evaluated the effects of intervention and MBMC treatment with myocardial infarction patients

目的:应用心肌灌注-代谢显像评价心肌梗死(AMI)后经冠状动脉介入移植治疗的疗效。方法:应用单光子发射型断层扫描(SPECT)静态心肌灌注代谢显像对比观察经冠状动脉成形术(PCI)+支架(stent)+心肌骨髓干细胞移植(MBMC)前后的心肌梗死区心肌血流灌注和代谢变化。结果:介入移植治疗前灌注缺损106节段,代谢缺损80节段;介入治疗后灌注缺损84节段,代谢缺损66节段,治疗前后灌注代谢差异无统计学意义(χ2=0.033,P>0.05);介入移植治疗前后人均灌注缺损分别是(3.13±1.14)节段和(2.54±1.30)节段,2组差异有统计学意义(P=0.0005);介入移植治疗前后人均代谢缺损分别是(2.42±1.28)节段和(2±1.28)节段,2组差异有统计学意义(P=0.004)。介入移植治疗后定量分析靶心图灌注显像的总记分(SPS)、代谢显像的总记分(SMS)以及严重度记分(SSS)较治疗前均有下降,但无统计学意义(P=0.184,P=0.608,P=0.166)。结论:静态心肌灌注-代谢显像是观察经冠状动脉介入移植治疗AMI疗效的一种方法。

Objective： Single-photon emission tomography （ SPECT ） protocol with fluorine-18 fluomdeoxyglucose 18F-FDG and a technetium-99m MIBI perfusion tracer is attractive because it permits assessment of both myocardial flow and glucose metabolism within a single study. The aim of this study was to investigate the myocardial distribution of 18F-FDG and a 99mTc-MIBI perfusion tracer on SPECT before and after PTCA ＋ Stent ＋ Autologous Intracoronary Mononuclear Bone Marrow Cell （MBMC） Transplantation with myocardial infarction patients. Method：Thirty-three cases patients of myocardial infarction were studied with SPECT before and after PTCA ＋ Stent ＋ MBMC to evaluate the changes of myocardial perfusion and metabolize imaging. Using eye approach the left ventricular wall was divided into nine segments and twenty segments to calculated the relative activity using semi- quantitative polar map the LV wall was divided into. Result： There were 106 segments perfusion defect and 80 segments metabolize defect before treatment and 84 segments perfusion defect and 66 segments metabolize defect after treatment（x^2 = 0.033, P 〉 0.05）. The average perfusion defect segments per person before and after treatment were 3.13 ±1.14 and 2.54 ± 1.3 （ P = 0. 000 5 ） and the average metabolize defect segments per person before and after treatment were 2.42 ± 1,28 and 2 ±1.28 （P = 0.004）. The Semi-quantitative visual scoring of the perfusion and metabolized images was performed by the 20-segment model. There were significant different before and after PCI ＋ stentt ＋ MBMC, The summed perfusion score （SIS） is 31.79 ± 11.73, summed metabolized score （SMS） is 23.10 ± 10.28, summed severity score（SSS） is 878.52 ± 513.78 before the treatment. The SIS is 29.38 ± 7.56, SMS is 22.14 ±8.77, SSS is 795.69 ± 413.97 after the treatment. Conclusion：The rest myocardial perfusion and metabolize imaging can be a method for to evaluate the effect of PTCA ＋ Stetu ＋ MBMC in myocardial infarction patients.