磁共振联合血管性血友病因子与循环内皮细胞对冠心病患者左心室心功能的评估价值

Evaluation of left ventricular function in patients with CHD by magnetic resonance imaging combined with vWF and circulating endothelial cells

目的研究磁共振联合外周血血管性血友病因子(vWF)、循环内皮细胞(CEC)对冠心病患者心肌活性及左心室功能的应用价值。方法选取2020年2月至2021年8月保定市第一医院收治的84例冠心病患者作为研究对象(研究组),选取同时段于我院检查无心血管疾病者为对照组(60例)。所有受试者均接受心脏MRI检查。Pearson相关性分析外周血vWF、CEC水平与心肌活性及左心室功能的相关性。结果研究组节段舒张末期容积(rEDV)、节段收缩末期容积(rESV)、首过灌注时间、心肌延迟强化信号值显著高于对照组,节段射血分数(rEF)、首过灌注最大上升斜率显著低于对照组,差异有统计学意义(P<0.01)。外周血vWF、CEC水平与rEDV、rESV、首过灌注时间、心肌延迟强化信号值呈正相关性,与rEF、首过灌注最大上升斜率呈负相关性(P<0.05,P<0.01)。有存活心肌患者rEDV、rESV、vWF、CEC显著低于无存活心肌患者,rEF显著高于无存活心肌患者(P<0.01)。磁共振、vWF、CEC联合诊断的敏感性为95.0%,磁共振、vWF、CEC单独诊断的敏感性分别为85.0%、75.0%、80.0%,联合诊断显著高于单独诊断。联合诊断的ROC曲线下面积为0.933(95%CI:0.886~0.951)。结论外周血vWF、CEC水平与冠心病患者心肌活性及左心室功能具有相关性,联合磁共振检测可有效提高诊断效能,对患者的早期筛查和诊断有重要的临床价值。

Objective To investigate the value of magnetic resonance combined with peripheral blood vWF and circulating endothelial cells(CEC)in evaluation of myocardial activity and left ventricular cardiac function in patients with coronary heart disease.Methods A total of 84 patients with coronary heart disease admitted to Baoding First Hospital from February 2020 to August 2021 were enrolled and assigned as the study group,and 60 individuals without cardiovascular disease during same period were selected as the control group.All subjects received cardiac MRI.Pearson correlation analysis was used to analyze the correlation of vWF level and CEC count in peripheral blood with myocardial activity and left ventricular function.Results Regional enddiastolic and end-systolic volumes(rEDV and rESV),first pass perfusion time and myocardial delayed enhancement signal value were significantly higher,while regional ejection fraction(rEF)and maximum slope of rise in the first pass perfusion were obviously lower in the study group than the control group(P<0.01).The levels of vWF and CEC in peripheral blood were positively correlated with rEDV,rESV,first pass perfusion time and myocardial delayed enhancement signal value,and negatively correlated with rEF and the maximum slope of first pass perfusion(P<0.05,P<0.01).rEDV,rESV,vWF and CEC were significantly lower,and rEF was significantly higher in the patients with viable myocardium than those without viable myocardium(P<0.01).The sensitivity of combined diagnosis of MRI,vWF and CEC was 95.0%.The sensitivity of single diagnosis of MRI,vWF and CEC was 85.0%,75.0%and 80.0%respectively.The combined diag-nosis had significantly higher performance than that of single diagnosis.The area under the ROC curve of the combined diagnosis was 0.933(95%CI:0.886-0.951).Conclusion The levels of vWF and CEC in peripheral blood are correlated with myocardial activity and left ventricular func-tion in patients with coronary heart disease.The combination of magnetic resonance detection can effectively improve the diagnostic efficiency,and has important clinical value for early screening and diagnosis of patients.