摘要
目的探讨肥厚型心肌病患者心肌纤维化相关因素。方法选取舟山医院2019年1月至2021年1月收治的肥厚型心肌病患者96例为研究对象。收集所有患者一般资料并行心脏磁共振(CMR)检查,通过钆对比剂延迟强化(LGE)判断是否存在心肌纤维化并计算LGE范围(LGE%)。根据是否存在心肌纤维化分为阳性组和阴性组,比较两组间各指标及与心肌纤维化范围的相关性。结果阳性组患者年龄[(42.84±14.38)岁]显著小于阴性组[(50.71±14.74)岁](t=2.04,P<0.05),美国纽约心脏病协会(NYHA)心功能Ⅲ/Ⅳ级占比[29.41%(20/68)]、N端B型利钠肽前体(NT-proBNP)[2761.73(1505.22,3784.62)ng/L]、心肌肌钙蛋白(cTnI)[0.971(0.447,1.687)μg/L]、肌酸激酶同工酶(CK-MB)[(3.25±2.65)μg/L]以及肌红蛋白(MYO)[(66.14±31.17)μg/L]均显著高于阴性组[3.57%(1/68)、862.35(551.48,1094.83)ng/L、0.146(0.037,0.256)μg/L、(0.73±0.22)μg/L、(28.82±2.34)μg/L](t=12.17、55.28、3.17、5.18、8.18,均P<0.05);阳性组患者左心室射血指数(LVEF)[(62.31±17.89)%]与心脏指数(CI)[(2.85±0.71)L·min^(-1)·(m^(2))-1]显著低于阴性组(t=2.89、6.18,均P<0.05),左心室舒张末期容积(LVDSV)[(56.32±17.28)mL/m^(2)]、左心室舒张末期最大室壁厚度(LVMWT)[(2.24±0.41)cm]以及左心室质量指数(LVMI)[(126.15±12.34)g/m^(2)]均显著高于阴性组(t=2.17、2.75、13.10,均P<0.05)。阳性组中重度肥厚18例,中度肥厚20例,轻度肥厚30例。两组各指标比较显示:NT-proBNP、cTnI以及LGE范围比较差异均有统计学意义(t=43.27、5.28、11.18,均P<0.05),且随着肥厚程度增加而增加。LGE%与患者年龄呈负相关,与NT-proBNP、cTnI、LVDSV、LVMWT以及LVMI均呈正相关,差异均有统计学意义(均P<0.05)。结论肥厚型心肌病患者心肌纤维化发生率较高,且纤维化的范围与患者年龄呈负相关,与NT-proBNP、cTnI、LVDSV、LVMWT以及LVMI均呈正相关。
Objective To investigate myocardial fibrosis-related factors in patients with hypertrophic cardiomyopathy.Methods Ninety-six patients with hypertrophic cardiomyopathy who received treatment in Zhoushan Hospital between January 2019 and January 2021 were included in this study.General data of all patients were collected.Cardiovascular magnetic resonance imaging was performed in all patients.Percentage of late gadolinium enhancement(LGE)was calculated.These patients were divided into positive and negative groups according to whether myocardial fibrosis existed.Related parameters were compared between the two groups.Correlations between related parameters and myocardial fibrosis range were analyzed.Results Patient age in the positive group was significantly lower than that in the negative group[(42.84±14.38)years vs.(50.71±14.74)years,t=2.04,P<0.05].The percentage of patients with New York Heart Association(NYHA)class III/IV heart function,N-terminal pro-brain natriuretic peptide(NT-proBNP)level,cardiac troponin(cTnI)level,creatine kinase-MB level,and myoglobin level in the positive group were 29.41%(20/68),2761.73(1505.22,3784.62)ng/L,0.971(0.447,1.687)μg/L,(3.25±2.65)μg/L and(66.14±31.17)μg/L,respectively,which were significantly higher than those in the negative group[3.57%(1/68),862.35(551.48,1094.83)ng/L,0.146(0.037,0.256)μg/L,(0.73±0.22)μg/L,(28.82±2.34)μg/L,t=12.17,55.28,3.17,5.18,8.18,all P<0.05].Left ventricular ejection fraction and cardiac index in the positive group were(62.31±17.89)%and(2.85±0.71)L·min^(-1)·(m^(2))-1,respectively,which were significantly lower than those in the negative group(t=2.89,6.18,both P<0.05).Left ventricular end-diastolic volume(LVEDV),left ventricular maximum wall thickness(LVMWT)and left ventricular mass index(LVMI)in the positive group were(56.32±17.28)mL/m^(2),(2.24±0.41)cm,(126.15±12.34)g/m^(2),which were significantly higher than those in the negative group(t=2.17,2.75,13.10,all P<0.05).In the positive group,18 patients had moderate and severe hypertrophy,20 patients had moderate hypertrophy,and 30 patients had mild hypertrophy.There were significant differences in NT-proBNP,cTnI level and(LGE)extent between positive and negative groups(t=43.27,5.28,11.18,all P<0.05).NT-proBNP,cTnI level and LGE extent increased with the increase in hypertrophy.Percentage of LGE was negatively correlated with patient age,and it was positively correlated with NT-proBNP,cTnI,LVDSV,LVMWT and LVMI.The differences were statistically significant(all P<0.05).Conclusion Patients with hypertrophic cardiomyopathy have a relatively high incidence of myocardial fibrosis.The extent of myocardial fibrosis is negatively correlated with patient age and it is positively correlated with NT-proBNP,cTnI,LVDSV,LVMWT and LVMI.
作者
金倩倩
孙思美
房兆飞
Qianqian Jin;Simei Sun;Zhaofei Fang(Department of Pharmacy,Zhoushan Hospital,Zhoushan 316000,Zhejiang Province,China;Department of Cardiovascular Medicine,Zhoushan Hospital,Zhoushan 316000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2022年第6期895-899,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省舟山市科技局市级公益类计划项目(2021C31044)。
关键词
心肌病
肥厚性
磁共振成像
心内膜心肌纤维化症
利钠肽
脑
肌钙蛋白
每搏输出量
人体质量指数
Cardiomyopathy,hypertrophic
Magnetic resonance imaging
Endomyocardial fibrosis
Natriuretic peptide,brain
Troponin
Stroke volume
Body mass index
