应用^(31)P磁共振波谱对心肌梗死后能量代谢变化的评价

Evaluated change of energetic metabolism after myocardial infarction by ^( 31)

目的 探讨3 1磷磁共振波谱 (3 1PMRS)在心肌梗死临床应用价值 ,评价心肌活力 ,为心肌梗死治疗方案决策提供依据。方法 健康志愿者 12例行3 1PMRS和共振成像 (MRI)检查 ,结果作为正常对照组。选择 10例心肌梗死病人 ,进行MRI和3 1PMRS检查 ,所有病人经冠脉造影等检查证实。结果 与正常对照组比较 ,患者存活心肌PCr/ATP比值无显著差异 ;病变区无活力心肌r-ATP -SNR(thesignaltonoiseratio)与对照组和存活心肌比较明显降低。结论 ①3 1PMRS可以提供存活心肌和梗死 (无活力 )心肌能量代谢变化特征 ,为3 1PMRS评价心肌活力的临床应用提供方法论。②顿抑心肌状态 ,高能磷酸盐代谢变化不是心肌顿抑心功能异常的直接病因。③3 1PMRS显示人心肌梗死能量代谢的变化 ,用3 1PMRS可以预测血管重建后心功能恢复情况。

Objective To study the value of 31 [HT5' P MRS as a passable tool to distinguish viable from non-viable tissue after myocardial infarction in human.Methods Performing MRI and 31 P MRS on 12 healthy volunteers who served as controls.Conducting heart MRI and 31 P MRS studies on 10 selected patients with MI,whose diagnosis of MI has been confirmed by coronary angiographies and some other tests.Results Healthy volunteers served as control group,in viable myocardium,PCr/r-ATP ratio was non-significant vs volunteers;a significant reduction of r-ATP signal-to-noise ratio(SNR) was observed (patients vs volunteers,P<0.05).Conclusions Z ① 31P MRS can provide metabolic characterization of infarcted and viable myocardium.The ability of 31 P MRS examination after reperfusion dramatically increases the likehood that 31 P MRS will have clinical utility for assessing postreperfusion myocardial viability.②The abnormalities of energy phosphate level noted in reperfused-viable (stunned) myocardium are not direct reason for the pathogenesis of mechanical stunning.③ 31P MRS can demonstrate altered energy metabolism in infarcted myocardium in humen.A prediction of functional recovery after revascularization may be possible using 31 P MRS.