本文關鍵詞：介入栓塞法建立小豬心肌梗塞模型及MRI研究　出處：《重慶醫(yī)科大學》2009年碩士論文　論文類型：學位論文

  更多相關文章： 介入 栓塞 小型豬 心肌梗塞 磁共振

【摘要】： 目的:利用小型豬建立心肌梗塞(Myocardial Infarction,MI)模型,比較正常與MI小豬MRI平掃表現(xiàn)及MRI灌注情況,并與其病理組織學對照,探索MI的MRI表現(xiàn)及其病理基礎,為臨床應用MRI診斷MI、監(jiān)測干細胞移植治療冠心病研究提供參考。 材料與方法:MI模型的建立:9頭雄性貴州小型豬,經(jīng)股動脈穿刺插管,將自制黑色絲線栓子推注到冠狀動脈左前降支(LAD)或左回旋(LCX)遠端。術(shù)前及術(shù)后第2天,分別抽血行心肌酶譜、肌鈣蛋白及血常規(guī)檢查。所有6頭存活小豬,術(shù)前及術(shù)后1、3、5周均進行MRI平掃及灌注掃描。術(shù)中與術(shù)后第二天死亡小豬只做了術(shù)前常規(guī)及灌注掃描。術(shù)后23天死亡小豬除行術(shù)前常規(guī)及灌注掃描外,還做了術(shù)后1、3周常規(guī)及灌注掃描。術(shù)后6周處死動物行病理組織學檢查。 MRI檢查技術(shù):掃描序列包括平掃T1WI、T2WI、Fiesta、Tags序列,以及Gd—DTPA增強MR首過灌注成像、MDE延遲時相掃描成像。灌注成像采用(Peffusion-Weighted Imaging,PWI)序列,TR:3.3ms,TE:1.4ms,FA:23°,采集40期圖像。經(jīng)耳緣靜脈注入Gd—DTPA0.1mmol/kg,注射流率:3.0mml/s,注射藥后即刻啟動掃描。 在常規(guī)掃描上比較術(shù)前和術(shù)后心臟形態(tài)、信號及收縮功能的變化。利用MRI灌注圖像建立信號強度-時間曲線,測量最大灌注斜率,最大峰值及峰值時間等。 結(jié)果:一、MI動物模型及病理組織學檢查 進行股動脈穿刺栓塞冠脈的9頭小豬均形成MI,1頭術(shù)中發(fā)生室顫死亡,1頭術(shù)后1天死亡;1頭于23天死亡。42天后處死其余動物,病理大體及切片觀察均見梗塞形成。MI模型存活率為66.7%(6/9)。所有受術(shù)小豬術(shù)前、術(shù)后均行冠脈造影。術(shù)前:各豬冠脈主干及各級分支血管通暢,管腔形態(tài)、大小未見異常。術(shù)后:所有受術(shù)小豬栓塞部位以下冠脈均無顯影。 MI模型實驗室檢查指標術(shù)后較術(shù)前均有不同程度增高。9頭受術(shù)小豬術(shù)前心電圖均未見異常。冠脈栓塞5～10分鐘后,3頭豬即在心電監(jiān)護Ⅰ、aVL、V1～V5導聯(lián)出現(xiàn)不同程度ST段抬高;其中1頭隨即轉(zhuǎn)變成室顫,最后心跳停止。 二、MRI表現(xiàn)及與病理組織學檢查對照關系 MRI平掃:小豬術(shù)前心臟MRI掃描,心臟大小、形態(tài)、信號、功能未見異常。6頭存活小豬術(shù)后(1、3、5周)均做了MRI平掃及灌注掃描。Fiesta電影掃描均可見不同程度心臟節(jié)段的搏動減弱,Taggs序列缺血局部心室壁的網(wǎng)格運動幅度減低,隨著時間延長,逐漸明顯,甚至運動消失或出現(xiàn)反向運動;與術(shù)前對比:左室射血分數(shù)減少,左室運動幅度減小,左室舒張期末、收縮期末肌壁厚度未見明顯改變。心臟大小、形態(tài)未見明顯改變�；铙w及離體心臟掃描梗塞灶部位、面積與病理完全一致。 MRI灌注成像:灌注用藥馬根維顯(Gadolinium-DTPA,GD-DTPA)。受術(shù)小豬術(shù)前心肌灌注后迅速強化,各節(jié)段心肌強化均勻,首過灌注未見低灌注區(qū),延遲灌注未見強化。6頭存活小豬術(shù)后(1、3、5周)均做了灌注掃描。首過灌注均發(fā)現(xiàn)灌注缺損,延遲掃描均見強化;低灌注區(qū)面積、信號值隨時間沒有明顯差異;首過灌注最大上升斜率,術(shù)后較術(shù)前降低。術(shù)后首過灌注最大上升斜率及延遲灌注發(fā)生延遲強化節(jié)段數(shù)隨時間有所減少。 結(jié)論:介入栓塞法能形成徹底的MI。常規(guī)MRI能發(fā)現(xiàn)心MI后的異常改變。MRI灌注成像能準確診斷、定位MI。MRI掃描能對MI長期跟蹤隨訪。
[Abstract]:Objective: to establish a myocardial infarction using miniature swine (Myocardial Infarction MI) model, compared with MI normal pig MRI scan and MRI perfusion, and pathology, to explore the MRI features and pathological basis of MI, for the clinical application of MRI diagnosis of MI, monitoring of stem cell transplantation in the treatment of coronary heart disease research to provide the reference.
Materials and methods: the MI model: 9 male Guizhou miniature pigs with catheterization of femoral artery, the self-made black thread embolus injection to the left anterior descending coronary artery (LAD) or left circumflex (LCX) distal. Second days before and after operation, respectively. Blood for myocardial enzymes, troponin egg Rhizoma Bletillae blood routine examination. All 6 survived pigs were performed MRI scan and perfusion 1,3,5 weeks before and after the surgery. The intraoperative and postoperative day second death piggy only do preoperative routine and perfusion scan. Pigs except for routine preoperative perfusion scan and death 23 days after operation, but also to do the 1,3 weeks after surgery and routine perfusion scan. Animal pathology examinations were performed at 6 weeks after operation.
MRI examination: the scanning sequences included plain T1WI, T2WI, Fiesta, Tags and Gd sequences, DTPA enhanced MR first pass perfusion imaging, MDE delayed phase scanning imaging. Perfusion imaging using (Peffusion-Weighted Imaging, PWI) TR:3.3ms, TE:1.4ms, FA:23 sequence, 40 degrees, collecting images. Injection of Gd - DTPA0.1mmol/kg. By the ear vein injection rate: 3.0mml/s, immediately start scanning after injection.
The changes of cardiac morphology, signal and systolic function before and after operation were compared on routine scanning. The signal intensity time curve was established by MRI perfusion image, and the maximum perfusion slope, maximum peak value and peak time were measured.
Results: 1. MI animal model and histopathological examination
9 piglets of femoral artery puncture coronary artery embolism were formed MI, fatal ventricular fibrillation occurred in 1 head, 1 head died 1 days after the operation; 1 on the 23 day death.42 days after the rest of the animal, infarction survival rate of.MI model was 66.7% and showed pathological section observation (6/9) of all. Of pigs before operation, postoperative underwent coronary angiography. Preoperative: the porcine coronary artery trunk and branch patency, lumen size, no abnormality. After the operation: all cases had no coronary embolism following pig development.
MI model laboratory indexes after operation were increased.9 of pig head preoperative electrocardiogram showed no abnormal coronary embolism. 5~10 minutes later, 3 pigs in the ECG I, aVL, V1 ~ V5 leads with varying degrees of ST elevation; 1 of them immediately head into ventricular fibrillation, finally to stop the heart.
Two, MRI expression and comparison with histopathological examination
MRI scan: Pig preoperative cardiac MRI scan, heart size, shape, signal, no abnormal function of.6 survived after pigs (1,3,5 weeks) were done MRI plain and perfusion.Fiesta scan were showed different degrees of heart beating segment decreased, grid motion amplitude Taggs sequence local ventricular wall ischemia the decreased with the prolongation of time, gradually, even sports disappear or reverse movement; compared with the preoperative left ventricular ejection fraction decreased left ventricular motion decreases, left ventricular end diastolic and end systolic muscle wall thickness had no obvious change. The size of heart, there was no obvious morphological change in vivo and in vitro cardiac scan. The infarct area and the pathological part, exactly the same.
MRI perfusion imaging: infusion Magnevist (Gadolinium-DTPA, GD-DTPA). Preoperative myocardial perfusion of pig quickly after strengthening, segments even strengthened, first pass perfusion was low perfusion, delayed perfusion was not enhanced.6 survival after resection of head pig (1,3,5 weeks) were done first pass perfusion perfusion scan. Showed perfusion defects were seen in delayed enhancement scan; area of low perfusion area, the signal value over time have no obvious difference; first pass perfusion maximum rise slope, postoperative perfusion decreased. The maximum rise slope of the first pass and delayed perfusion occurred delayed enhancement segments decreased with time.
Conclusion: interventional embolization can form a thorough MI. routine MRI, which can detect abnormal changes after cardiac MI..MRI perfusion imaging can accurately diagnose, and MI.MRI scanning can be a long-term follow-up for MI.

【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R445.2;R542.22;R-332

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