摘要
目的探讨缺血性心脏病(IHD)患者经体外心脏震波治疗(CSWT)后心功能改善与基质细胞衍生因子1(SDF-1)表达、内皮祖细胞(EPCs)增殖的相关性,进而揭示CSWT改善IHD患者心功能的机制。方法前瞻性收集2018年4月至2019年12月在昆明医科大学第一附属医院诊治的IHD患者20例,行内科标准治疗及CSWT,1个月内完成9次CSWT。治疗前,采用超声心动图左室整体纵向应变(GLS)和单光子发射计算机断层扫描(SPECT)行99Tcm-甲氧基异丁基异腈心肌灌注显像(MPI)识别存活心肌,定位缺血节段;治疗中,实时心电、血压和血氧饱和度监测;并于治疗前、治疗后1和6个月,抽取外周静脉血检测SDF-1和EPCs。患者于治疗后1和6个月随访,内容包括GLS和MPI评价局部心肌收缩功能和血流灌注,记录纽约心脏病协会(NYHA)心功能分级、加拿大心血管学会(CCS)心绞痛分级、西雅图心绞痛量表(SAQ)、明尼苏达心力衰竭生活质量量表(MLHFQ)评分、36条简明健康状况调查表(SF-36)评分、6 min步行距离(6MWD)和硝酸甘油用量,观察SDF-1、EPCs指标变化,分析患者心功能改善情况与SDF-1、EPCs的相关性。结果20例IHD患者共43个缺血治疗节段接受了9次CSWT,血流动力学稳定,无任何不良事件发生。与治疗前比较,治疗后1和6个月的NYHA心功能分级、CCS心绞痛分级、MLHFQ评分和硝酸酯类用量均降低,SAQ评分、SF-36评分和6MWD均提高(均为P<0.05);治疗节段GLS绝对值增加,MPI局部灌注改善(均为P<0.05);SDF-1和EPCs指标呈增高趋势(均为P<0.05)。相关分析显示,SDF-1(r=-0.56,P=0.00)和EPCs(r=-0.26,P=0.04)均与NYHA心功能分级呈负相关,SDF-1与EPCs无相关性(r=0.06,P=0.62)。结论CSWT通过促进IHD患者血管内皮细胞增生而提高心肌灌注、改善心功能,SDF-1与EPCs升高与心功能改善呈正相关。
Objective To investigate the correlation between the improvement of cardiac function and the expression of stromal cell-derived factor 1(SDF-1)and the proliferation of endothelial progenitor cells(EPCs)in patients with ischemic heart disease(IHD)after extracorporeal cardiac shock wave therapy(CSWT),and to reveal the mechanism by which CSWT improves cardiac function in IHD patients.Methods Prospectively,20 patients with IHD in the First Affiliated Hospital of Kunming Medical University from April 2018 to December 2019 underwent standard medical treatment and CSWT,with 9 CSWTs completed within 1 month.Before treatment,left ventricular global longitudinal strain(GLS)and 99Tcm-myocardial perfusion imaging(MPI)with single photon emission computed tomography(SPECT)were performed.Patients were followed up at 1 and 6 months after treatment with GLS and MPI to evaluate local myocardial systolic function and blood flow perfusion,recording New York Heart Association(NYHA)cardiac function classification,Canadian Cardiovascular Society(CCS)angina classification,Seattle Angina Questionnaire(SAQ),Minnesota Living with Heart Failure Questionnaire(MLHFQ)scores,36-item Short-Form Health Status Survey(SF-36)scores,6 minute walk distance(6MWD)and nitroglycerin dosage,and observing SDF-1,and EPCs index changes,analyze the correlation between improvement of patients’cardiac function and SDF-1 and EPCs.Results Twenty patients with IHD received 9 sessions of CSWT in a total of 43 ischemic treatment segments and were hemodynamically stable without any adverse events.Compared with pre-treatment,NYHA cardiac function class,CCS angina class,MLHFQ score and nitrate dosage were reduced and SAQ score,SF-36 score and 6MWD were improved at 1 and 6 months after treatment(all P<0.05);absolute GLS values increased and local perfusion of MPI improved in the treated segments(all P<0.05);SDF-1 and EPCs indexes showed an increasing trend(both P<0.05).Correlation analysis showed that SDF-1 was negatively correlated with NYHA cardiac function class(r=-
作者
张华胜
宋文娟
杨洪文
方东
杨春芳
马雪娟
刘利萍
谷颖
赵月
孙钺
张雅文
王钰
Zhang Huasheng;Song Wenjuan;Yang Hongwen;Fang Dong;Yang Chunfang;Ma Xuejuan;Liu Liping;Gu Ying;Zhao Yue;Sun Yue;Zhang Yawen;Wang Yu(Intensive Care Unit,the First People’s Hospital of Kunming,Affiliated Calmette Hospital of Kunming Medical University,Kunming 650224,China;Department of Cardiology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Nuclear Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)
出处
《中国心血管杂志》
2022年第1期11-16,共6页
Chinese Journal of Cardiovascular Medicine
基金
云南省科技厅-昆明医科大学应用基础研究联合专项基金(2018FE001)
昆明医科大学研究生创新研究基金(2019S022)。
关键词
体外心脏震波治疗
心肌缺血
心肌灌注
局部心肌收缩功能
Extracorporeal cardiac shock wave therapy
Myocardial ischemia
Myocardial perfusion
Regional myocardial contractile function
