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目的利用经静脉心肌超声造影(IMCE)观察心肌梗死患者自体骨髓单个核细胞移植术前后心肌微循环的变化。方法40例急性心肌梗死患者在病情稳定后7～10d,行延迟经皮冠状动脉成形术(PCI)。随机分成骨髓细胞移植组(20例)和对照组(20例),观察术前、术后1月、术后6月左心室舒张末内径(LVDd),左室射血分数(LVEF)和术前及术后1个月的IMCE,测量平台期的心肌显像增大强度A,曲线上升平均斜率β及A与β之积在手术前后的变化。结果移植组LVEF由术前的(37.26±4.21)1月后上升到(54.42±5.26)(P<0.05);而对照组差异不显著(38.86±4.63对40.28±4.56)(P>0.05)。LVDd移植组术后6月与术前比较差异不显著(50.23±3.42对52.48±3.26)(P>0.05);而对照组(50.96±2.68对64.31±3.28)(P<0.05)心脏有扩大趋势。IMCE示手术后相关心肌节段的A、β及A.β均较术前显著增加。其中A.β(dB/s)移植组由术前的2.37±0.16(dB/s)增加到术后的15.60±0.24(dB/s);较对照组(2.06±0.12至7.98±0.23)增加更为明显(P<0.05),示急性心肌梗死延迟PCI术后梗死相关节段心肌血流灌注速度和灌注量均有增加,自体骨髓单个核细胞移植组增加更明显。结论自体骨髓单个核细胞移植可改善梗死区心肌微循环,明显增加心肌血流量。
Objective To observe the changes of myocardial microcirculation before and after autologous bone marrow mononuclear cells transplantation in patients with myocardial infarction by intravenous myocardial contrast echocardiography (IMCE). Methods 40 patients with acute myocardial infarction were treated with delayed percutaneous transluminal coronary angioplasty (PCI) 7 ~ 10 days after the disease was stable. Randomly divided into bone marrow transplantation group (20 cases) and control group (20 cases). The changes of left ventricular end-diastolic diameter (LVDd), left ventricular ejection fraction (LVEF) Before and after 1 month of IMCE, measuring the stage of myocardial imaging increased intensity A, the average slope of the curve β and A and β product before and after the change. Results The LVEF in the transplantation group increased from (37.26 ± 4.21) months to (54.42 ± 5.26) months before surgery (P <0.05), while the difference was not significant in the control group (38.86 ± 4.63 vs. 40.28 ± 4.56) (P> 0.05). There was no significant difference between the LVDd group and the preoperative one at 6 months (50.23 ± 3.42 vs. 52.48 ± 3.26) (P> 0.05), while in the control group (50.96 ± 2.68 vs. 64.31 ± 3.28) (P <0.05) . IMCE showed A, β and A.β in the relevant myocardial segments after surgery were significantly increased compared with preoperative. In the group of A.beta. (DB / s), the preoperative 2.37¡À0.16 (dB / s) increased to 15.60¡À0.24 (dB / s) postoperatively compared with the control group (2.06¡À0.12 to 7.98¡À0.23) (P <0.05). It showed that the infarct-related myocardial perfusion rate and perfusion volume were increased after PCI in the acute myocardial infarction group, and the autologous bone marrow mononuclear cell transplantation group increased more obviously. Conclusion Autologous bone marrow mononuclear cells transplantation can improve myocardial microcirculation in infarction area and increase myocardial blood flow obviously.