自动功能成像评价经冠状动脉骨髓单个核细胞移植治疗急性心肌梗死的疗效

目的 应用自动功能成像(AFI)评价经冠状动脉自体骨髓单个核细胞(MBMC)移植治疗急性心肌梗死(AMI)的治疗效果.方法 收集临床诊断为AMI患者22例,行冠状动脉介入检查及MBMC移植治疗.观察移植的安全性,临床状况,心肌缺血区域的改变及细胞移植术前、后左心室心功能变化.结果 移植后3例于MB MC细胞注入后出现发冷反应,予以地塞米松治疗后好转；3例细胞注入时出现短暂自限性室性期前收缩,术后24 h持续ECG监测未再出现心律失常；手术前、后实验室指标无明显差异.移植3个月后心肌显像示11例原梗死区缩小、活性区增大；超声心动图随访检查发现,MBMC移植后3～6个月内,左心室射血分数增加7.73％,左心室每搏输出量增加10.81％,AFI显示患者左心室室壁纵向应变术后有明显改善,牛眼图可见缺血节段减小,与PET的靶心图改变一致.结论 经冠状动脉自体MBMC移植修复梗死心肌安全有效；AFI及常规超声心动图可为观察其疗效提供影像学基础.

Automated function imaging evaluation on therapeutic efficiency of intracoronary transplantation of mononuclear bone marrow cells in patients with acute myocardial infarction

Objective To evaluate the curative effect of intracoronary autologous mononuclear bone marrow cell (MBMC) transplantation in patients with acute myocardial infarction (AMI) by using automated function imaging (AFI). Methods Twenty-two patients with AMI were enrolled and received percutaneous intervention of coronary artery. The safety of operation, clinical condition, myocardial ischemia areas and function of the left ventricular were observed, respectively. Results After transplantation, 3 of 22 patients felt cold, and got better after dexamethasone injecting. Three patients had limited premature ventricular contractions. There was no arrhythmia with ECG for 24 h. No difference between pre- and post-operation laboratory tests was detected in 22 patients. Three months after transplantation, viable myocardium was found in the infarct regions in 11 cases by PET. Echocardiography revealed improvement of left ventricular function after MBMC transplantation, including LVEF increasing 7.73% and stroke volume increasing 10.81%. The longitudinal strain improved, and the left ventricular ischemic segments decreased on bull-eyes' map of AFI, being similar to the changes on target map of PET. Conclusion Intracoronary transplantation of autologous MBMC is safe and effective for the treatment of patients with AMI. Combining with routine echocardiography, AFI can be used to evaluate the therapeutic efficiency in a handy and functional way.