CAJ | 학술논문

目的用正电子发射计算机断层显像(positron emission computed tomography,PET-CT)评估曲美他嗪对缺血性心脏病心肌细胞代谢的影响.方法入选30例缺血性心脏病患者,随机分为治疗组(A组)和对照组(B组),在常规治疗基础上分别接受曲美他嗪(60 mg/d)和安慰剂治疗,随访12个月.治疗前、后均行心肌门控单光子发射计算机断层扫描显像(gated single photon emission computerized tomography,SPECT)、PET-CT心肌显像以及心脏彩色多普勒超声检测,选择并测定血流灌注-代谢匹配(均降低)节段的心肌标准化摄取值(SUV).结果 A组在12个月后左心室射血分数(LVEF)由(37.9±5.0)%增加至(42.3±10.4)%(P＜0.05),B组由治疗前(38.1±4.6)%增加至(40.1±5.5)%(P＜0.05);SPECT心肌显像显示,治疗组血流-代谢匹配节段的静息评分A组从3.9±1.0降低至2.4±2.3(P＜0.01);B组从4.0±0.7降低为2.8±1.8(P＜0.05),但两组比较差异无统计学意义.A组匹配节段心肌18F-FDG的平均SUV由6.3±1.5增加为9.8±4.7(P＜0.05),B组平均SUV值由治疗前6.4±1.2增加至7.5±2.3(P＞0.05).结论 PET-CT心肌显像与心肌SPECT血流灌注显像相结合能够检测缺血而存活心肌,曲美他嗪能够改善缺血心肌葡萄糖摄取能力,增加心肌葡萄糖氧化代谢,改善心脏功能.
목적 용정전자발사계산궤단층현상(positron emission computed tomography,PET-CT)평고곡미타진대결혈성심장병심기세포대사적영향.방법 입선30례결혈성심장병환자,수궤분위치료조(A조)화대조조(B조),재상규치료기출상분별접수곡미타진(60 mg/d)화안위제치료,수방12개월.치료전、후균행심기문공단광자발사계산궤단층소묘현상(gated single photon emission computerized tomography,SPECT)、PET-CT심기현상이급심장채색다보륵초성검측,선택병측정혈류관주-대사필배(균강저)절단적심기표준화섭취치(SUV).결과 A조재12개월후좌심실사혈분수(LVEF)유(37.9±5.0)%증가지(42.3±10.4)%(P＜0.05),B조유치료전(38.1±4.6)%증가지(40.1±5.5)%(P＜0.05);SPECT심기현상현시,치료조혈류-대사필배절단적정식평분A조종3.9±1.0강저지2.4±2.3(P＜0.01);B조종4.0±0.7강저위2.8±1.8(P＜0.05),단량조비교차이무통계학의의.A조필배절단심기18F-FDG적평균SUV유6.3±1.5증가위9.8±4.7(P＜0.05),B조평균SUV치유치료전6.4±1.2증가지7.5±2.3(P＞0.05).결론 PET-CT심기현상여심기SPECT혈류관주현상상결합능구검측결혈이존활심기,곡미타진능구개선결혈심기포도당섭취능력,증가심기포도당양화대사,개선심장공능.
Objective Trimetazidine(TZM)has been shown to have anti-ischemia properties by optimizing ischemic myocardium metabolism.We evaluated the effect of TZM on myoeardial metabolism with Positron Emission Computed Tomography(PET-CT)in patients with ischemic cardiomyopathy.Methods TZM(60 mg/d,n=15)or placebo(n=15)was randomly applied to ischemic cardiomyopathy patients on top of conventional therapy for 12 months.Color Doppler Flow Imaging(CDFI),18F-FDP PET-CT imaging and 99mTc-MIBI gated single photon emission computerized tomography(SPECT)imaging were performed at study begin and after 12 months.LVEF with CDFI,summed rest scores(SRS)with SPECT and standard uptake value(SUV)with PET-CT of the segments which were perfusion-metabolism matched and decreased were determined respectively.Results After 12months,LVEF of the therapy group was increased from (37.9±5.0)% to (42.3±10.4)%(P＜0.05),while the control group increased from(37.9±4.6)%to (40.1±5.5)%(P＞0.05);SRSs of the matched segments of the therapy and the control were reduced from 3.9±1.0 to 2.4±2.3(P＜0.01)and 4.0±0.7 to 2.8±1.8(P＜0.05) respectively,while LVEF and SRSs were similar at study begin and after 12 months between these two groups.SUV of myocardial segments classified as myocardial perfusion-metabolism matched was increased from 5.3±1.5 to 9.8±4.7 in the therapy group(P＜0.05)and from 5.4±1.2 to 6.0±2.3(P＞0.05)in the placebo group,SUV was significantly higher in the therapy group than that in placebo group after 12 months(P＜0.05).Conclusion SPECT and 18F-FDG imaging combination could be used to detect the surviving myocardium and chronic trimetazidine treatment could increase the glucose metabolism of ischemic cardiomyocytes in patients with ischemic cardiomyopathy.