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目的应用组织追踪法评价急性心肌梗死患者自体骨髓干细胞移植后受损心肌的功能恢复情况,探讨该技术对评价左心室节段收缩功能的应用价值。方法入选的16例急性心肌梗死患者均经冠状动脉造影证实为前降支病变,通过随机双盲法分为干细胞移植组(A组,8例)和常规治疗组(B组,8例),治疗后随访1周和3个月的组织多普勒超声心动图,用组织追踪法测量心尖四腔、二腔及心尖长轴观基底段、中间段与心尖段共18个节段的位移,并根据位移曲线计算长轴方向延迟收缩节段数占总节段数比例,与左心室射血分数(LVEF)、心肌核素显像随访结果相对照。结果①A组移植后3个月缺血心肌节段位移较移植1周后明显增大(P<0.05),而B组3个月和1周节段位移差异无显著性意义(P>0.05);②A组移植后3个月延迟收缩节段比例较移植1周后明显减少(25%对9%,P<0.05),B组3个月延迟收缩节段比例亦减少,但差别无显著性意义(29%对14%,P>0.05);③A组移植后3个月LVEF值与移植后1周比较呈升高趋势[(53±9)%对(57±12)%,P>0.05],B组移植后3个月LVEF值与1周比较呈下降趋势[(54±5)%对(52±7)%,P>0.05];④A组移植后3个月梗死区即刻和延迟相心肌核素摄取均较1周增强,SPECT心肌灌注图像评分较1周时显著下降(21.75±9.60对18.75±11.80,P<0.05)。B组移植后3个月梗死区?
Objective To evaluate the functional recovery of impaired myocardium after autologous bone marrow stem cell transplantation in patients with acute myocardial infarction by tissue tracing and to explore the value of this technique in evaluating the systolic function of left ventricular segments. Methods Sixteen patients with acute myocardial infarction were confirmed by coronary angiography as anterior descending coronary artery disease. The patients were randomly divided into three groups: group A (n = 8) and group B (n = 8) Tissue Doppler echocardiography was performed after 1 week and 3 months of follow-up. The displacement of 18 segments in the apical segment, middle segment and apical segment of apical four-chamber, According to the displacement curve, the ratio of the number of delayed systolic segments in the long axis to the total number of segments was calculated and compared with the follow-up results of left ventricular ejection fraction (LVEF) and myocardial radionuclide imaging. Results ① The displacement of ischemic myocardium in group A at 3 months after transplantation was significantly higher than that at 1 week after transplantation (P <0.05), but there was no significant difference in group B at 3 months and 1 week (P> 0.05) ; ② The proportion of delayed systolic segments in group A at 3 months after transplantation was significantly decreased after 1 week (25% vs 9%, P <0.05), while the proportion of delayed systolic segments at 3 months in group B also decreased, but the difference was not significant (29 ± 14 vs. P> 0.05). ③ The LVEF of group A at 3 months after transplantation was increased compared with that at 1 week after transplantation (53 ± 9)% vs (57 ± 12)%, P> 0.05 ]. The LVEF of group B at 3 months after transplantation was decreased compared with that at 1 week [(54 ± 5)% vs (52 ± 7)%, P> 0.05]; ④ Immediate and delayed infarction Compared with 1 week, SPECT myocardial myocardial perfusion imaging score significantly decreased compared with that of 1 week (21.75 ± 9.60 vs 18.75 ± 11.80, P <0.05). B group 3 months after transplantation infarct?