急性心肌梗死患者LGE-CMR评价结果及其与血清心肌标志物的关系

Relationship between evaluation results of LGE-CMR and serum myocardial markers in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者对比剂延迟强化心脏磁共振成像(LGE-CMR)评价结果及其与心肌标志物水平的关系。方法选取因AMI住院治疗的185例患者,患者入院至磁共振检查时间为1~5 d,平均(3.10±1.40)d,根据LGE-CMR结果分为对比剂延迟强化(LGE)阴性组64例和LGE阳性组121例,再根据LGE阳性节段数将LGE阳性组分为瘢痕心肌节段数<6组(59例)和瘢痕心肌节段数≥6组(62例)。收集患者一般资料并进行组间比较;采用酶联免疫吸附试验检测血清N-末端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)水平;采用心脏MRI检查获取患者左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室舒张末期内径(LVEDD)、左心室球形指数(SI)。采用多因素Logistic回归分析AMI患者LGE阳性的影响因素。结果瘢痕心肌节段数≥6组高密度脂蛋白胆固醇(HDL-C)、LVEF、SI低于LGE阴性组和瘢痕心肌节段数<6组,NT-proBNP、cTnI、Myo、LVEDV、LVESV、LVEDD、Gensini评分及高血压、高血脂患者比例高于LGE阴性组和瘢痕心肌节段数<6组;瘢痕心肌节段数<6组HDL-C、LVEF、SI低于LGE阴性组,NT-proBNP、c TnI、Myo、LVEDV、LVESV、LVEDD、Gensini评分及高血压、高血脂患者比例高于LGE阴性组;瘢痕心肌节段数≥6组糖尿病患者比例高于LGE阴性组(P<0.05)。NT-proBNP、cTnI、高血压是AMI患者LGE阳性的独立影响因素(P<0.05)。结论LGE识别的心肌瘢痕与心功能受损严重程度有关,且心肌瘢痕累及的节段数越多,其血清NT-proBNP、cTnI、Myo水平越高。

Objective resonance(LGE-CMR)evaluation results and levels of myocardial markers in patients with acute myocardial infarction(AMI).Methods selected.The time of duration from admission to magnetic resonance examination was 1-5 days,with an average of(3.10±1.40)days.According to the results of LGE-CMR,patients were divided into the late gadolinium enhancement(LGE)negative group(n=64)and the LGE positive group(n=121).Then,according to the number of LGE positive segments,the LGE positive group was sub-divided into the scar myocardial segments<6 group(n=59)and the scar myocardial segments≥6 group(n=62).General data of patients were collected and compared between groups.The serum levels of N-terminal proB-type natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI)and myoglobin(Myo)were detected by enzyme-linked immunosorbent assay(ELISA).Data of left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular end diastolic dimension(LVEDD)and left ventricular sphericity index(SI)were measured by cardiac MRI.Multivariate Logistic regression was used to analyze the factors affecting LGE positivity in patients with AMI.ResultsHigh density lipoprotein cholesterol(HDL-C),LVEF and SI were significantly lower in the number of cicatricial myocardial segments≥6 group than those in the LGE negative group and the number of cicatricial myocardial segments<6 group.The NT-proBNP,cTnI,Myo,LVEDV,LVESV,LVEDD,Gensini score,the proportions of hypertension and hyperlipidemia patients were higher in the number of cicatricial myocardial segments≥6 group than those in the LGE negative group and the number of cicatricial myocardial segments<6 group.HDL-C,LVEF and SI were significantly lower in the number of cicatricial myocardial segments<6 group than those in the LGE negative group,and the NT-proBNP,cTnI,Myo,LVEDV,LVESV,LVEDD,Gensini score,the proportions of hypertension and hyperlipidemia patients were higher than those in LGE negative group.The proportion of diabetic patients was higher in the cicatricial myocardial segments≥6 group than that of the LGE negative group(P<0.05).NT-proBNP,cTnI and hypertension were independent influencing factors of LGE positive in patients with AMI(P<0.05).Conclusion The myocardial scar identified by LGE is related to the severity of cardiac dysfunction,and the more segments involve in myocardial scar,the higher the serum levels of NT-proBNP,cTnI and Myo are.