DISA显像对冠状动脉搭桥术同时行骨髓单个核细胞移植的研究

99^Tc^m-MIBI and 18^F-FDG DISA imaging in the evaluation of CABG combined with autologous bone marrow mononuclear cell transplantation in patients with myocardial infarction

目的应用18^F-脱氧葡萄糖（FDG）和99^Tc^m-甲氧基异丁基异腈（MIBI）门控SPECT同时双核素（DISA）显像法评估陈旧性心肌梗死（OMI）患者经冠状动脉搭桥术（CABG）同时行自体骨髓单个核细胞移植术后的心肌血流灌注、细胞代谢和心功能改善情况。方法20例经病史、心电图和冠状动脉造影确诊为OMI的患者，分为常规CABG（A组，11例）和常规CABG＋自体骨髓单个核细胞移植术组（B组，9例），分别于术前1周和术后4个月行DISA门控心肌断层显像。采用SPSS12．0软件进行数据处理，两样本均数比较用配对t检验。结果20例OMI患者中，A组不匹配节段共52个，99^Tc^m-MIBI、18^F-FDG摄取分数术后分别为1．75±0．68和2．13±0．74，与术前的1．48±0．75和1．90±0．75相比，差异有统计学意义（t=3．25和2．37，P均〈0．05）；匹配节段共47个，术后99^Tc^m-MIBI、18^F-FDG摄取分数分别为1．70±0．66和1．89±0．63，与术前的1．64±0．70和1．87±0．54相比，差异无统计学意义（t=0．72和0．22，P均〉0．05）。B组不匹配节段共45个，99^Tc^m-MIBI、18^F-FDG摄取分数术后分别为1．53±0．66和2．00±0．64，与术前的1．24±0．68和1．71±0．76相比，差异有统计学意义（t＝2．93和2．56，P均〈0．05）；匹配节段36个，99^Tc^m-MIBI、18^F-FDG摄取分数术后分别为1．22±0．76和1．78±0．64，与术前的0．94±0．75和1．50±0．74相比，差异有统计学意义（t=2．71和3．37，P均〈0．05）。20例患者术后射血分数、每搏输出量分别为（34．2±9．7）％和（58．8±27．1）ml，较术前的（28．5±9．4）％和（45．6±17．0）ml明显增加（t=1．79和1．86，P均〈0．05）；术后舒张末容积、收缩末期容积分别为（180±77）和（122±57）ml，与术前的（168±64）和（124±54）ml相比，无明显变化（t=0．53和0．34，P均〉0．05）。结论CABG＋自体骨髓单个核细胞移植术后心肌血流灌注和心肌细胞代谢均得以改善；评估CABG＋干细胞移植术后整体心功能参数的最佳指标为左室射血分数和每搏输出量。

Objective Autologous bone marrow mononuclear cell transplantation is a treatment modality under investigation for severe coronary heart disease. Its beneficial effects on ventricular function, myocardial perfusion and metabolism remain to be evaluated. The present study proposed a 18^F-fluorodeoxyglucose （FDG） and 99^Tc^m-methoxyisobutylisinitrile （MIBI） dual-isotope simultaneous acquisition （DISA） imaging technique to assess the effects of coronary artery bypass grafting （CABG） combined with autologous bone marrow mononuclear cell transplantation in patients with old myocardial infarction （OMI）. Methods Twenty patients with OMI, whose diagnosis was confirmed with angiography, were divided into a conventional CABG group （ group A, n = 11 ） and CABG ＋ autologous bone marrow mononuclear cell transplantation group （ group B, n = 9 ）. All subjects underwent gated cardiac DISA tomography at one week preoperatively and four months postoperatively. The segmental myocardial uptake of the tracers was scored as 3, 2, 1 and 0. Paired - samples t test was used to compare data of the two groups. Results In group A, there were 52 perfusion/metabolism mismatched segments. 99^Tc^m-MIBI and 18^F-FDG uptake scores of these segments increased from preoperatively 1.48 ± 0.75 （ 99^Tc^m-MIBI ） and 1.90 ± 0.75 （ 18^F-FDG ） to postoperatively 1.75 ±0.68 and 2.13 ± 0.74 （t = 3.25 and 2.37, both P 〈 0.05）. In the 47 matched segments, there was no significant change of the myocardial uptake scores before and after operation （ 1.64 ± 0.70 and 1.87 ± 0. 54 vs 1.70 ± 0.66 and 1.89 ± 0.63, t = 0.72 and 0. 22, both P 〉 0. 05 ）. However, in group B, there was significant increase of the myocardial uptake scores both in mismatched segments and matched segments. In the 45 mismatched segments of this group, preoperative and postoperative 99^Tc^m-MIBI/18^SF-FDG uptake scores were 1.24 ±0.68/1.71 ± 0. 76 and 1.53 ± 0.66/2.00 ± 0. 64, respectively （ t = 2.93 and 2. 56, both P 〈 0. 01 ）. In the 36 matched segments, preoperative and postoperative 99^Tc^m-MIBI/18^F-FDG uptake scores were 0. 94 ± 0.75/1.50 ± 0.74 and 1.22 ± 0. 76/1.78 ± 0. 64, respectively （ t = 2.71 and 3.37, both P 〈 0. 05）. Left ventricular ejection fraction （EF） and stroke volume （SV） significantly increased from preoperatively （ 28.5 ± 9.4 ） % and （45.6 ± 17. 0） ml to postoperatively （ 34.2 ± 9.7 ） % and （58.8 ± 27.1 ） ml in all 20 subjects （t = 1.79 and 1.86, both P 〈 0.05）. There was no significant change in left ventricular end-diastolic volume （EDV） and end-systolic volume （ESV） （t = 0. 53 and 0. 34, both P 〉 0. 05）. Conclusions CABG combined with autologous bone marrow mononuclear cell transplantation may improve myocardial perfusion and glucose metabolism in OMI patients. Left ventricular EF and SV may be the better parameters to evaluate the overall cardiac function after CABG and stem cell transplantation.