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背景:组织多普勒超声心动图被证明可以用来评价心脏的整体和局部功能,但用于评价骨髓基质细胞移植对阿霉素所致兔心肌病的连续观察研究较少。目的:利用组织多普勒超声心动图评价骨髓基质细胞直接注射治疗阿霉素所致心肌病心肌功能的变化。设计、时间及地点:随机对照动物实验,于2002-09/2003-12在华中科技大学同济医学院附属协和医院超声科实验室完成。材料:雄性成年日本大耳白兔28只,体质量(2.0±0.2)kg,利用阿霉素诱导其中20只制备扩张型心肌病模型。方法:造模成功后,20只白兔分为细胞移植组和PBS组,每组10只。8只生理盐水处理组作为假手术组。细胞移植组于实验开始第8周每只兔分别取其骨髓进行骨髓基质细胞培养。第12周进行细胞荧光标记后,于心外膜直接注射回各自兔的左室侧壁心肌处。PBS组于第12周注射相同剂量的PBS培养液作为对照。另外8只作为假手术组仅开胸,每次给予相同剂量生理盐水。主要观察指标:细胞移植前及移植后4周利用常规和组织多普勒超声心动图评价左室整体和局部功能;组织学和荧光检测观察心肌细胞形态变化。结果:①细胞移植组组织多普勒发现局部注射区组织速度增高,由(4.0±1.1)cm/s到(5.3±1.2)cm/s(P<0.05),而整体功能未见明显改善。PBS组及假手术组整体和局部心肌功能均未见改善。②细胞移植后4周存活的细胞仍可见DAPI荧光标记。组织学检查发现注射区附近心肌损伤减轻,凋亡较少。结论:骨髓基质细胞治疗扩张型心肌病可以改善局部心肌功能,组织多普勒可以检测出局部心肌功能的改善,为细胞移植提供了一种有效的评价手段。
BACKGROUND: Tissue Doppler echocardiography has been shown to be useful in assessing the global and local cardiac function. However, few studies have been conducted to evaluate the continuous observation of adriamycin-induced cardiomyopathy in bone marrow stromal cells transplantation. OBJECTIVE: To assess the changes of myocardial function in cardiomyopathy induced by doxorubicin by direct injection of bone marrow stromal cells by tissue Doppler echocardiography. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the Laboratory of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2002 to December 2003. MATERIALS: Twenty eight male adult Japanese white rabbits with a body weight of (2.0 ± 0.2) kg were used to prepare dilated cardiomyopathy model by using doxorubicin. Methods: After the successful modeling, 20 white rabbits were divided into cell transplantation group and PBS group, 10 in each group. Eight saline-treated groups served as sham-operated group. In the cell transplantation group, bone marrow was obtained from each rabbit for bone marrow stromal cell culture at the 8th week of the experiment. After 12 weeks of fluorescent labeling of cells, the epicardium was injected directly back into the left ventricular myocardium of each rabbit. PBS group at the 12th week, the same dose of PBS was injected as a control. The other 8 rats were thoracotomy only as the sham-operated group, and the same dose of saline was given each time. MAIN OUTCOME MEASURES: Left ventricular global and regional function were assessed by routine and tissue Doppler echocardiography before transplantation and 4 weeks after transplantation. Morphological changes of cardiomyocytes were observed by histology and fluorescence detection. Results: (1) Tissue Doppler imaging showed that the tissue velocity increased from (4.0 ± 1.1) cm / s to (5.3 ± 1.2) cm / s in the cell transplantation group (P <0.05). There was no improvement in global and regional myocardial function in PBS group and sham operation group. ② Cells surviving 4 weeks after cell transplantation were still visible DAPI fluorescent markers. Histological examination found that myocardial injury near the injection area was reduced, with less apoptosis. CONCLUSION: Bone marrow stromal cells can improve local myocardial function in patients with dilated cardiomyopathy, and tissue Doppler can detect the improvement of local myocardial function, which provides an effective evaluation method for cell transplantation.