99Tcm-MIBI静息门控心肌灌注显像在心肌梗死干细胞移植治疗中的价值

摘要

目的 用99Tcm-甲氧基异丁基异腈(MIBI)静息门控心肌灌注显像的方法 ,评价急性心肌梗死(AMI)患者自体骨髓间质干细胞(MSC)移植术治疗的疗效.方法 AMI患者31例,均行经皮冠状动脉介入治疗(PCl)术,其中18例患者作为试验组,于PCI术后行自体MSC移植术治疗,PCI术后拒绝行细胞移植治疗的13例患者作为对照组.于PCI术前,术后1,3和6个月进行99Tcm-MIBI静息门控心肌灌注断层显像,评价心肌血流灌注及心功能改善程度.统计学处理采用SPSS 11.0软件,行t检验.结果 所有患者术后1个月放射性稀疏节段数明显减少,术后3个月和6个月放射性缺损节段数试验组(2.37±1.09和2.21±0.93)较对照组(3.24±0.93和3.21±1.05)明显减少(t=2.32,2.79,P均<0.05);与术前[(35.4±16.7)%和(32.8±15.9)%]相比,术后6个月试验组[(57.2±14.3)%]和对照组[(44.8±11.7)%]患者左心室射血分数(LVEF)均显著升高(t=4.27,2.18,P均<0.05),试验组患者LVEF明显高于对照组(t=2.58,P<0.05).结论 心肌梗死患者自体MSC移植术后,应用99Tcm-MIBI静息门控心肌灌注显像随访和评价疗效有一定临床价值.%Objective Myocardial cell regeneration therapy is one of the most researched topics in modern medical science. The objective of this study was to evaluate the clinical value of 99Tcm-methoxyisobutylisonitrile (MIBI) rest gated myocardial perfusion imaging in patients with acute myocardial infarction (AMI) treated by stem cell transplantation. Methods Thirty-one patients with AMI were all treated by percutaneous coronary intervention (PCI). And 18 of them subsequently had mesenchymal stem cell (MSC) transplantation therapy. All the patients were examined by 99Tcm-MIBI rest gated myocardial perfusion imaging at the time before and after PCI to evaluate the left ventricular myocardial perfusion and function. The t-test was used to compare data statistically with SPSS 11.0. Results The number of myocardial segments with perfusion abnormalities decreased in all the AMI patients 1 month after PCI. The number of myocardial segments with perfusion defects decreased 3 to 6 months after PCI in the patients treated by MSC transplantation (2.37±1.09 and 2.21±0.93 ) when compared with the control group without MSC transplantation therapy (3.24±0.93 and 3.21±1.05, t =2.32,2.79, both P <0.05).The left ventricular ejection fraction (LVEF) of the patients treated by MSC transplantation increased 6 months after PCI compared with the control group [(57.2±14.3) % and (44.8±11.7) %, respectively, t=2.58, P<0.05]. Condusion 99Tcm-MIBI rest gated myocardial perfusion imaging is an effective functional imaging to evaluate the therapeutic response in patients with AMI treated by MSC transplantation.