暴发性心肌炎的心脏磁共振延迟强化特征分析

The characteristics of cardiac magnetic resonance late gadolinium enhancement in patients with fulminant myocarditis

目的探讨暴发性心肌炎的心脏磁共振(CMR)延迟强化(LGE)特征。方法选择2013年5月至2018年12月金华市中心医院临床诊断为急性心肌炎,CMR增强检查提示LGE为阳性的患者45例,其中暴发性心肌炎9例,非暴发性心肌炎36例。比较两组患者临床资料、左心室结构和功能参数及CMR LGE特征。结果暴发性心肌炎组患者白细胞升高、C反应蛋白升高、心肌酶谱升高、肌钙蛋白I升高、脑钠肽升高患者比例均高于非暴发性心肌炎组,差异均有统计学意义(均P<0.01)。两组左心室结构、功能参数比较,差异均无统计学意义(均P>0.05)。暴发性心肌炎组LGE累及第11节段病例数低于非暴发性心肌炎组,LGE节段中第4节段强化段数高于非暴发性心肌炎组,差异均有统计学意义(均P<0.05)。结论暴发性心肌炎患者CMR LGE在各心肌节段中的分布具有一定特征,在临床诊断和鉴别诊断有重要作用。

Objective To investigate the characteristics of cardiac magnetic resonance(CMR)late gadolinium enhancement(LGE)in patients with fulminant myocarditis.Methods Forty-five acute myocarditis patients with CMR LGE were retrospectively collected in Jinhua Municipal Central Hospital from May 2013 to December 2018.Of them,9 cases were fulminant myocarditis and 36 cases were non-fulminant myocarditis.Clinical data,left ventricular structural and functional parameters and the characteristics of CMR LGE were compared between the two groups.Results White blood cell,C-reactive protein,myocardial enzymes,troponin I and brain natriuretic peptide were significantly higher in fulminant myocarditis group than in non-fulminant myocarditis group(all P<0.01).Left ventricular structural and functional parameters were not different between the two groups(all P>0.05).There were significantly less patients with LGE of the 11th segment in fulminant myocarditis group than in non-fulminant myocarditis group.The number of LGE in the 4th segment was significantly higher in fulminant myocarditis group than in non-fulminant myocarditis group(all P<0.05).Conclusion The CMR LGE of fulminant myocarditis is characteristic,which plays an important role in clinical diagnosis and differential diagnosis.