中文摘要：

目的评价磁共振成像（MRI）在冠心病陈旧性心肌梗死合并心功能不全患者诊断中的价值，并分析干细胞移植手术的疗效。方法20例冠心病陈旧性心肌梗死患者，男18例，女2例，年龄（59．5±10．1）岁，平均分成2组（每组10例），干细胞移植组行冠状动脉旁路移植术（CABG）＋干细胞移植，对照组仅行CABG术，术前均行心脏MRI及双核素单光子发射计算机断层（SPECT）进行存活心肌显像检查，术后6个月复查心脏MRI。用MRI评价干细胞移植后左心功能改善及心脏MRI延迟增强显像判断左室存活心肌的准确性。结果两组左室射血分数（LVEF）均有明显改善，但手术前后变化值比较差异无统计学意义。干细胞移植组左室舒张末期容积（LVEDV）手术前后变化值为（9．91±39．50）ml，与对照组的（-22．34±31．35）ml比较，差异有统计学意义（P〈0．05）；干细胞移植组室壁增厚率变化值高于对照组（11．40％±11．53％比2．27％±7．20％，P〈0．05），其余两组心功能参数变化值比较差异均无统计学意义。心脏MRI延迟增强显像与氟-18-脱氧葡萄糖（^18F-FDG）心肌代谢存活心肌显像具有较好的一致性，Kappa=0．446（P〈0．001）。以^18F—FDGSPECT心肌代谢显像为金标准，心脏MRI延迟增强显像敏感度为68．3％，特异度为92．5％。结论MRI能够准确判断冠心病陈旧性心肌梗死患者左室容积和功能，对心肌梗死后存活心肌的判断具有同^18F—FDGSPECT相近的特异性，但敏感性略低。MRI可用于心肌干细胞移植前诊断与移植后早期疗效的判定。

英文摘要：

Objective To evaluate the therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction （OMI） by MRI. Methods Heart failure patients [ NYHA 2. 7 ±0. 7, male = 18, mean age （59. 5 ± 10. 1 ）y] with OMI were randomly divided into 2 groups （group A： CABG＋ stem cell transplantation, group B： CABG; n = 10 each）. Left ventricular （LV） function was measured by MRI, viable myocardium was detected by ^18F-FDG myocardial metabolism imaging and late contrast-enhanced at baseline and 6 months post intervention. Results LVEF and LVEDV at baseline for group A were （20. 71 ± 6.09 ） % and （ 172. 73±32. 74） ml, and for group B were （27. 59±2. 31 ） % and （155. 13± 28.36）ml, respectively （P 〉 0. 05 ）. The LVEF was equally improved in group A and B （mean 8. 63% vs. 10. 37%, P 〉 0. 05 ） while ALVEDV was significant higher in group A than that in group B [ （9. 91 ± 39. 50） ml vs. （ - 22. 34 ±31.35 ） ml, P 〈 0. 05 ]. Ventricular wall thickening ratio at 6 months post intervention was significantly higher in group A than that in group B [ （ 11.40±11.53） % vs. （2.27 ± 7.20）% ,P 〈 0. 05 ]. Late contrast-enhanced MRI results correlated with ^18F-FDG myocardial metabolism imaging SPECT well in assessment of myocardial viability （ kappa value： 0. 446, P 〈 0. 001 ; sensitivity： 68.3% and specificity： 92.5%）. Conclusions Stem cell therapy on top of CABG aggravated LV remodeling in heart failure patients with old myocardial infarction. The specificity of MRI is similar to ^18F- FDG SPECT while the sensitivity is inferior to ISF-FDG SPECT on detecting viable myocardium.