核素心肌显像对自体骨髓干细胞原位移植治疗心肌梗死后心功能不全患者临床效果的评价

目的探讨核素心肌显像对自体骨髓干细胞原位移植（BMCT）治疗心肌梗死后心功能不全患者临床效果的评价。方法选择54例陈旧性心肌梗死伴心功能不全患者，BMCT使用集落细胞刺激因子150～300μg皮下注射，每日一次，注射3—5d，使白细胞总数达到2．3×10^10-3．0×10^10。选择同期住院符合入选标准的54例接受常规治疗的陈旧性心肌梗死伴心功能不全患者作为对照组。仪器为Siemens e．Cam双探头单光子发射计算机断层成像仪，显像剂为99^Tc^m-甲氧基异丁基异腈（MIBI）心肌灌注显像，采用低能高分辨准直器，矩阵64×64。Hann滤波后行图像重建，以极坐标靶心图半定量分析法，对治疗前后显像极坐标靶心图行归一化处理。〉40％者为存活心肌，≤40％为梗死区，勾画出放射性缺损区。心肌梗死面积=心肌放射性缺损区面积／靶心图总面积×100％。结果治疗组治疗后与治疗前比较，平均灌注缺损面积减少，纽约心功能分级降低，6分钟步行距离明显延长，左室射血分数明显提高，室壁运动积分指数明显下降，左室舒张末容积明显缩小，血清脑利钠肽降低，差异均有统计学意义；而对照组治疗后各项指标虽有改善，但与治疗前比较差异无统计学意义。治疗组治疗后与对照组治疗后各项指标比较，差异均有统计学意义（P〈0．05）。治疗组死亡8例中6例年龄超过70岁。结论99^Tc^m-MIBI心脏核素显像评价BMCT术后近期疗效较有价值。BMCT治疗心肌梗死后心功能不全可改善患者的心功能，增加运动积分，生活质量改善。同时也提示骨髓干细胞原位移植对高龄老年心肌梗死后心功能不全患者疗效差。

Imaging of autologous bone marrow stem cell transplantation in the treatment of myocardial infarction in situ after heart failure in patients with clinical results of the evaluation

Objective To study myocardial imaging in autologous bone marrow stem cell transplantation in the treatment of myocardial infarction in situ after heart failure in patients with clinical results of the evaluation. Methods 54 patients with old myocardial infarction with heart failure patients, 32 cases of men,22 women, aged 48 - 76 years （ average 61.78 years）, the control group 54 cases, 30 cases of men ,24 women, aged 46 -74 year old （average 58.78 years ）. Transplantation of bone marrow stem cells used in situ colony stimulating factor of 150 - 300μg subcutaneous injection, once a day, the injection of three to five days,moving to a total of interleukin 2.3 × 10^10 -3.0 × 10^10. Siemens e. Cam equipment for the two probes SPECT, imaging agent for 99^Tc^m-MIBI myocardial perfusion imaging, using low-energy high- resolution collimator, Matrix 64 × 64. Hann filter later, image reconstruction, plans to target semi-polar quantitative analysis, the treatment before and After imaging to map polar target normalized. 〉 40% of those for myocardial viability, ≤40% for the infarction, outlining radioactive defects. Myocardial infarction area = cardiac defect area of radioactive / target map total area ×100%. Results After treatment with the control group after treatment were significantly improve the indicators, P 〈 0. 05 ; before treatment and the treatment group, after treatment to reduce the average area of perfusion defect, NYHA classification lower, 6 - MWT walking distance from the obvious extension, LVEF markedly improved, WMSI significantly decreased, while the control group after treatment targets, although improved, but not statistically significant ; echocardiography tips at the end of the treatment group left ventricular volume significantly reduce serum BNP treatment and control groups are a certain degree of reduced heart function has improved, but the treatment group improved significantly. Eight cases of death in 6 cases over the age of 70 years. Conclusions 99^Tc^m-MIBI of myocardial imaging for autologous bone marrow stem cell transplantation in the treatment of myocardial infarction in situ after heart failure patients can improve heart function of patients, improve the ejection fraction, increased movement points, six minutes walking time extension, the quality of life improved echocardiography tips at the end of the treatment group left ventricular volume significantly reduced, endsystolic volume decreased left ventricular ejection fraction increased serum BNP two groups have a certain degree of reduced heart function has improved to varying degrees,, but the treatment group improved significantly more. At the same time also suggested that bone marrow stem cell transplantation for senior citizens aged in situ after myocardial infarction heart failure patients worse effect.