半定量法评价自体骨髓单个核细胞移植治疗急性心肌梗死的疗效

目的 利用”F-FDGPET心肌葡萄糖代谢显像，采用3种半定量方法，评价自体骨髓单个核细胞经冠状动脉移植治疗急性心肌梗死的疗效。方法30例根据临床症状、体征、心电图和血清酶学改变而确诊的急性心肌梗死患者，急诊溶栓再通后入选本研究，其中18例作为细胞移植组（PTCA＋支架＋细胞移植术），12例作为对照组（PTCA＋支架）。2组患者均分别于术前1～2天和术后6个月～1年内行^18F-FDG PET心肌葡萄糖代谢显像。采用3种不同的半定量方法，即目视法、靶心图相减法和心肌葡萄糖代谢值（GMV）比较法，对比治疗前后原梗死心肌节段葡萄糖代谢程度的变化，从而间接观察原梗死心肌节段内有代谢活力的心肌的数量变化。结果（1）30例患者手术均安全。其中28例患者完成了前后两次PET检查，两组中各有1例患者因患有严重糖尿病，术后复查PET时无法获取满意的图像而退出本次研究。（2）细胞移植组17例患者①目视法观察到有11例（64．71％）患者的原梗死心肌节段葡萄糖代谢程度有所增加，治疗后梗死节段数与治疗前相比有明显减少（t=3．543，P〈0．05），提示治疗有效；②靶心图相减法观察到14例（82．35％）患者的原梗死心肌节段葡萄糖代谢程度有所增加；③心肌葡萄糖代谢值比较法观察到12例（70．59％）患者的原梗死心肌节段葡萄糖代谢程度有所增加，治疗后GMV与治疗前相比有明显增加（t=2．245，P〈0．05），提示治疗有效。（3）对照组11例患者：①目视法观察到有4例（36．36％）患者的原梗死心肌节段葡萄糖代谢程度有所增加，但治疗前后梗死节段数的配对t检验结果为t=1．166，P〉0．05，差异无统计学意义；②靶心图相减法观察到6例（54．55％）患者的原梗死心肌节段内葡萄糖代谢程度有所增加；③心肌葡萄糖代谢值比较法观察到5例（45．45％）患者的原梗死心肌节段内葡萄糖代谢程度有所增加，但进行治疗前后GMV的配对t检验的结果为t=-1．254，P〉0．05，差异无统计学意义。结论PTCA＋支架＋自体骨髓单个核细胞经冠状动脉移植治疗急性心肌梗死的疗效优于单纯PTCA＋支架治疗，从代谢角度分析，该优势可能与自体骨髓单个核细胞经冠状动脉移植后心肌再生有关。3种半定量分析方法中，心肌葡萄糖代谢值比较法较传统的目视法和靶心图相减法更为适合临床疗效的评价。

Assess the effect of transplantation of autologous mononuclear bone marrow cells in patients with acute myocardial infarction by semi-quantitative analysis

Objective To investigate the efficacy of the treatment by intracoronary transplantation of autologous mononuclear bone marrow cells(MBMC) in patients with acute myocardial infarction(AMI) by using three different semi-quantitative methods.Methods Thirty patients with AMI were divided into 2 groups,MBMC transplantation group(18 patients) and control group(12 patients).They all underwent 18F-FDG PET cardiac metabolic imaging before and after treatment.Using three different semi-quantitative methods(visual analysis,polar map subtraction and cardiac glucose metabolic value comparison) to observe the change of metabolic extent in the infarct defected regions between pre-and post-treatment.Results All the 30 patients completed the operation safely,28 of them completed the comparison study and 1 patient for each group did not complete the study because the image quality was poor.Among the 17 patients(MBMC transplantation group),visual analysis,polar map subtraction and cardiac glucose metabolic value comparison showed 11(64.71%),14(82.35%) and 12(70.59%) patients whose glucose metabolic extent in the infarct defected regions were improved,respectively.Among the 11 patients(control group),visual analysis,polar map subtraction and cardiac glucose metabolic value comparison showed 4(36.36%),6(54.55%) and 5(45.45%) patients whose glucose metabolic extent in the infarct defected regions were improved,respectively.Conclusion The therapeutic effect of PTCA+stent+MBMC was better than PTCA+stent in treating AMI patients,the reason may be attribute to MBMC-associated myocardial regeneration.Among the three semi-quantitative methods,the method of cardiac glucose metabolic value comparison was superior to the traditional methods in assessing the therapeutic effect.