扩张型心肌病心肌纤维化LGE评价与左心功能及NT-proBNP相关性研究

doi:10.12117/jccmi.2019.10.005

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摘要目的：探讨延迟增强心脏MRI（Late gadolinium enhancement-cardiac MRI，LGE-CMR）检测的心肌纤维化与左心功能、血浆NT-proBNP水平的相关性。方法：经完整临床资料诊断为扩张型心肌病（Dilated cardiomyopathy，DCM）的22例患者纳入研究，所有患者接受心脏磁共振成像（Cardiac magnetic resonance imaging，CMR）检查及血浆NT-proBNP水平检测。根据钆对比剂延迟强化（Late gadolinium enhancement，LGE）结果，将DCM患者分为两组，A组：LGE阴性组，B组：LGE阳性组；再进一步根据LGE阳性节段数，将B组分为Ba组（LGE阳性节段数＜5），Bb组（LGE阳性节段数≥5）；比较各组间左心结构功能参数和NT-proBNP水平差异。左心结构功能参数包括左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）、每搏输出量（SV）、心输出量（CO）、心指数（CI）、左室心肌质量（LVMM）、短轴缩短率（FS）、左心室舒张末期内径（LVEDD）、球形指数（SI）。结果：22例DCM患者中，16（73%）例患者存在心肌纤维化，最常累及的部位为基底部的前间壁（13例）和下间壁（13例），其次为中间部的前间壁（7例）和下间壁（7例）。A组与B组相比，LVEDV、LVESV、LVEF、LVMM、FS、LVEDD、SI、NT-proBNP差异有统计学意义（P＜0.05），B组的DCM患者心功能更差，心室重构越重。Ba组与Bb组相比， LVEDV、LVESV、LVEF、LVMM、FS、LVEDD、SI、NT-proBNP差异均有统计学意义（P＜0.05），Bb组NT-proBNP水平更高。结论：LGE所识别的心肌纤维化及其累及范围与DCM左心室重构后结构功能受损的严重程度相关，心肌纤维化累及的节段数越多，心功能越差，心室重构程度越严重，血浆NT-proBNP水平也越高。

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	张颖雪1
	赵新湘2

关键词 ：心肌病, 扩张型, 心室功能, 左, 磁共振成像

Abstract：Objective: To investigate the relationship between myocardial fibrosis detected by late gadolinium enhancement(LGE) and the left ventricular function as well as plasma NT-proBNP levels in dilated cardiomyopathy(DCM). Methods: Twenty-two cases of DCM were enrolled. All patients were examined by CMR and had NT-proBNP detection. According to the results of LGE, all cases were divided into group A(without LGE) and group B(with LGE). Group B were further divided into two subgroups, including group Ba(the number of LGE segments＜5) and group Bb(the number of LGE segments≥5). The LVEDV, LVESV, LVEF, SV, CO, CI, LVMM, FS, LVEDD SI and plasma NT-proBNP levels were analyzed and compared among groups. Result: There were sixteen(73%) cases with myocardial fibrosis detected by LGE. The most frequent locations were basal anteroseptal(13 cases) and basal inferoseptal segments (13 cases). The second most frequent locations were mid-anteroseptal(7 cases) and mid-inferoseptal segments(7 cases). Eight cases showed mutiple segments of myocardial fibrosis. The significant differences of LVEDV, LVESV, LVEF, LVMM, FS, LVEDD SI and plasma NT-proBNP levels were seen between group A and group B(P＜0.05), and the group B had poorer cardiac function and ventricular remodeling. Compared group Ba and group Bb, the significant differences of LVEDV, LVESV, LVEF, LVMM, FS, LVEDD SI and plasma NT-proBNP levels were seen(P＜0.05), and the group Bb showed worse ventricular remodeling and higher NT-proBNP levels. Conclusion: The presence and extent of myocardial fibrosis detected by LGE can reflect the severity of cardiac structure and function after ventricular remodeling in patients with DCM. The more numbers of myocardial fibrosis segments in patient with DCM are found, the poorer cardiac function, the worse ventricular remodeling and the higher the plasma NT-proBNP level will happen.

Key words： Cardiomyopathy, dilated Ventricular function, left Magnetic resonance imaging

收稿日期: 2018-10-22

PACS:	Ｒ542.2
	Ｒ331.3
	Ｒ445.2

基金资助:云南省中青年学术技术带头人培养项目（2015HB06）；云南省医学学科带头人培养项目（D-201646）；云南省联合专项重点项目；云南省高校科技创新团队支持计划资助。

通讯作者: 赵新湘，昆明医科大学第二附属医院放射科，650101。E-mail：zhaoxinxiang06@126.com

作者简介: 张颖雪（1989-），女，河南南阳人，住院医师。E-mail：651540689@qq.com

引用本文:

张颖雪1，赵新湘2. 扩张型心肌病心肌纤维化LGE评价与左心功能及NT-proBNP相关性研究[J]. 中国临床医学影像杂志, 2019, 30(10): 703-707.
ZHANG Ying-xue1, ZHAO Xin-xiang2. Myocardial fibrosis detected by late gadolinium enhancement in dilated cardiomyopathy and the relationship between left ventricular function and plasma NT-proBNP levels. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(10): 703-707.

链接本文:

http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.10.005 或 http://www.jccmi.com.cn/CN/Y2019/V30/I10/703

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