梗死心肌血运重建术后心肌血流、脂肪酸代谢的变化及与心室壁运动的关系

Changes of Myocardial Perfusion and Fatty Acid Metabolism and the Relation to Ventricular Wall Motion After Revascularization in the Infarcted Myocardium

目的：探讨急性心肌梗死患者血运重建术后心肌血流、脂肪酸代谢的变化及与心室壁运动的关系。方法：急性心肌梗死后行直接经皮冠状动脉腔内成形术（PTCA）者20例，于发病的急性期（2周内）及慢性期（3个月）进行201铊（201T1）、123碘-β-甲基碘苯脂十五烷酸（123I-BMIPP）双核素的单光子发射计算机断层摄影术（SPECT）及X线左心室造影。将左心室分成9个节段，采用4级的视觉评分方法，进行201T1、123I-BMIPP分布的评价，同时对局部心室壁运动进行5级评价。结果：从急性期至慢性期，201T1、123I-BMIPP的总核素分布异常程度积分及201TI及123I-BMIPP不匹配明显降低（P＜0.01），急性期123I-BMIPP的核素分布异常程度积分与局部心室壁运动呈明显正相关（r=0.710），急性期201T1及123I-BMIPP不匹配与心室壁运动的改善程度呈良好的正相关（r=0.756）。结论：PTCA的施行使心肌血流、脂肪酸代谢及201T1及123I-BMIPP不匹配在慢性期明显恢复，且急性期201T1及123I-BMIPP不匹配对预测左心室功能的改善是有用的。

Objective:To investigate the changes of myocardial perfusion,fatty acid metabolism and their relation to ventricularwall motion after revascularization in the patients with acute myocardial infarction (AMI).Methods: In the 20 patients who underwent direct percutaneous transluminal coronary angioplasty (PTCA) after theonset of AMI, 201TI,123I-β－methyliodophenyl-pentadecan acid (123I-BMIPP ) dual myocardial single photon emission computed tomography (SPECT) (201TI/123I-BMIPP SPECT) and X-Ray left ventricular angiocardiography (LVG) were performed in acute phase (within 2 weeks) and chronic phase (3 months). Left ventricle was divided into nine segments anduptake of 201TI and 123I-BMIPP were determined by four scoring system visually (Seventy score,SS). Regional wall motion(RWM) of left ventricle was evaluated by five classes.Results:From acute phase to chronic phase, total seventy score (TSS) of 201TI and 123I-BMIPP were significantly decreased (P＜0.01),as well as 201TI, 123I-BMIPP mismatch (P＜0. 01 ). SS of 123I-BMIPP in the acute phase was significantlycorrelated with RWM (r=0.710), moreover,there were highly positive correlation between 201TI, 123I-BMIPP mismatch andrecovery of RWM (r=0. 756).Conclusion: The results indicate that myocardial perfusion,fatty acid metabolism and 201TI, 123I-BMIPP mismatch wereobviously recovered in the chronic phase of AMI by revascularization. 201TI,123I-BMIPP mismatch in the acute .phase wasuseful for the prediction of recovery of left ventricular function.