心肌内心电图Tslew诊断大鼠急性排斥反应的可靠性  

Reliability of using tslew of intramyocardial electrogram to diagnose acute rejection after heart transplantation in rats

作　　者：史加海[1] 孟旭[1] 韩杰[1] 张海波[1] 陈阳天[1] 贾一新[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2011年第1期35-38,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评估心肌内心电图（IMEG）心室起搏（VER）的T波后支斜率（Tslew）用于诊断大鼠异体心脏移植术后急性排斥反应的可靠性.方法 建立改良Ono大鼠腹部异位心脏移植动物模型,对照组（同基因移植）10只,实验组（异基因移植）30只.在供心右室流出道、左室游离壁和左室心尖部的心肌处分别埋置心表起搏电极,用两根导线作为起搏电极,描记VER,测Tslew.对照组术后第7天、实验组分别在术后3、5、7天处死,移植心脏作病理活检.结果 术后3、5、7天各时点,对照组Tslew差异无统计学意义,实验组呈进行性下降,术后3～5天、3～7天之间两两差异有统计学意义（P＜0.05）;两组间比较第5、7天差异有统计学意义（P＜0.05）,实验组Tslew变化与病理相关（P＜0.05）;Tslew的ROC曲线下面积为0.9474,95%可信区间（0.8753～1. 0000）;在最佳分割点（≤90%）灵敏度94.74%,特异度81.82%,阳性预测值和阴性预测值、符合率90%.Tslew≤92%为阳性分割点,灵敏度100%,特异度63.64%;≤85%作为阳性分割点,特异度90.91%,灵敏度78.95%.结论 Tslew是诊断大鼠心脏移植术后急性排斥反应的可靠指标;在最佳分割点,Tslew具有良好的诊断价值,缺乏心内膜活检条件时可以作为替代或补充;在适当分割点,Tslew可以作为急性排斥反应筛选的敏感指标.Objective This study aimed to evaluate the reliability of Tslew in survelliance of allograft rejection after heart transplantations in rats. Methods Forty rats underwent modified Ono＇s heterotopic heart transplantation. The autonomous IMEG and VER were recorded with epicardiac pacing leads fixed at right ventricular outflow tracts, left ventricular apex and free wall. Tslews were detected daily in these 10 syngeneic and 30 allogeneic transplants. Syngeneic transplants were sacrificed on 7th postoperative day and allogeneic transplants were sacrificed on 3rd, 5th and 7th postoperative days, respectively.Histopathologic studies were performed at the same time. Results On the 3rd ,5th and 7th postoperative days Tslews depressed gradually in the allogeneic group. The depressions between 3rd and 5th, 3rd and 7th were obvious（ P 〈0.05 ）. No significant differences were observed in the syngeneic group. Tslews differed between the two groups at 5th and 7th postoperative days （ P 〈0.05 ）. The Depression correlated with histopathologic results. Area under ROC（ receiver operating characteristic） curve （AUC） of Tslew was 0.9474 and the 95% confidence interval（CI） was （0. 8753 -1. 0000 ）. At the cutoff point of 92% （ ≤92% considered positive）, Tslew had a sensitivity （Se） 100%, specificity （Sp） 63.64%, positive predictive value （PV ＋ ）82.61%, negative predictive value （PV-） 100%, respectively. At the cutoff point 85%, Sp 90.91%, Se 78.95%, PV ＋93.75 %, PV- 71. 43%. At the best cutoff point 90%, Tslew had a Se 94.74%, Sp 81. 82%, PV ＋ 82.61%, PV- 90%.Whereas QRS had a Se 68.42%, Sp 90.91%, PV ＋ 92.86%, PV- 62.50% at the best cutoff point of 72.3%. Conclusion Tslew of VER are reliable indexs to monitor acute allograft rejection after heart transplantations in rats. Having great diagnostic value, Tslew may be used as a replacement for EMB at the best cutoff point when EMB can＇ t be performed. At cutoff point of 92%, Tslew may be used as a screening index.

关 键 词：心脏移植 移植物排斥 心电描记术 

分 类 号：R-332[医药卫生] R654.2