急性心肌梗死MRI与心肌坏死标记物及心电图的相关性研究  

The correlation study of cardiovascular MRI with cardiac biomarkers and electrocardiography in patients with acute myocardial infarction

作　　者：张青[1] 王振常[1] 鲜军舫[1] 田其昌[1] 赵波[1] 吴超[1] 张华[1] 史旭波[2] 李田昌[2] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730 [2]首都医科大学附属北京同仁医院心血管中心,100730

出　　处：《中华放射学杂志》2009年第1期27-31,共5页Chinese Journal of Radiology

摘　　要：目的探讨心脏MRI确定的心肌梗死的梗死质量、梗死百分比、左心室功能等参数与肌酸激酶同工酶（CK—MB）峰值、肌钙蛋白T（TnT）峰值及心电图（ECG）的相关性。方法对19例首次发病3—7d的急性心肌梗死患者行心脏MR检查。采用1．5TMR仪行首过灌注成像及延迟强化成像。分别评价每例患者的梗死质量、梗死百分比、左心室功能，记录TnT峰值、CK—MB峰值并分析ECG。对正态分布资料行Pearson相关性检验，对非正态分布资料行Spearman相关性检验。用独立样本t检验进行2组计量资料的均数比较。结果19例患者的梗死质量中位数为6．3g，与左心室射血分数（LVEF）（54．1±15．4）％呈负相关（r=-0．563，P=0．012），与TnT峰值（中位数为0．8μg／L，r=0．487，P=0．0340）、左心室收缩末期容积指数（LVESVI；中位数为23．4mE／m2，r=0．480，P=0．038）相关。梗死百分比（中位数为6．0％）分别与TnT峰值（r=0．583，P=0．009）、CK—MB峰值（中位数为43．0U／L，r=0．470，P=0．042）、每搏输出量[LVSV；（57．6±15．0）ml，（r=-0．482，P=0．036）]相关。TnT峰值还与LVSV相关（r=-0．524，P：0．021）。心肌梗死sT段抬高与非sT段抬高相比，受累段数（中位数分别为3．0和2．0，t=2．972，P=0．009）更多，TnT峰值（中位数分别为1．0和0．7μg/L，t=2．245，P=0．041）、CK—MB峰值（中位数分别为43和35U／L，t=2．508，P=0．024）更高。结论急性期心肌梗死的梗死质量直接影响左心室功能。TnT峰值是反映梗死百分比及左心室功能的较好指标，ST段抬高心肌梗死的范围更大。Objective To determine the correlation of cardiovascular MRI with cardiac biomarkers ancl electrocardiography（ECG） in acute myocardial infarction （MI）. Methods Nineteen patients with first acute MI were selected to undergo MRI on a 1.5 T system within 3--7 days after the onset of symptoms. A first-pass perfusion scan was performed with the administration of Gd-DTPA at a speed after cine MRI for global left ventricle （LV） functions. Delay-enhanced MRI was performed by using an ECG-gatcd inversion- recovery fast-gradient echo-pulse sequence 5 to 10 minutes later with second bolus injection at a speed. Infarct mass （IM） , percentage size of infarction （PSI） and LV functions were compared with peak troponin T （peak TnT） and peak creatine kinase-MB fraction （peak CK-MB）. The 12-lead ECG was analysed for ST- elevation on admission. Pearson and Spearman correlation test and independent-Sample t test were used for statistics. Results The IM （ median 6.3 g） was correlated with peak TnT （ median 0. 8 μg/L, r = 0. 487, P = 0. 0340） and left ventricle end-systolic volume index （ LVESVI ） （median 23.4 mL/m2, r = 0. 480, P =0. 038 ） , IM showed a negative correlation with left ventricle ejection fraction（LVEF） （54. 1 ± 15.4）% （r = - 0. 563, P = 0. 012 ）. The PSI （ median 6. 0% ） was correlated with peak TnT（ r = 0. 583, P = 0. 009） , peak CK-MB（median43.0 U/L,r =0.470, P=0.042）and LVSV [（57.6 ± 15.0）ml,r = -0.482, P = 0. 036], peak TnT was also correlated with LVSV（r = -0. 524,P =0. 021 ）. There were more involved segments （IS） （ t = 2. 972, P = 0. 009 ）, higher peak TnT （ t = 2. 245, P = 0. 041 ） and peak CK-MB （ t =2. 508, P = 0. 024）in ST-elevation MI （STEMI） than in non ST-elevation MI （NSTEMI）. Conclusions IM directly imquences LV functions in acute MI. Peak TnT was a better biomarker reflecting PSI and LV functions. There were more involved segments in STEMI than in NSTEMI.

关 键 词：心肌梗死 磁共振成像 生物学标记 心电描记术 

分 类 号：R686[医药卫生—骨科学]