心肌内心电图诊断心脏移植术后急性排斥反应的研究  

Intramyocardial electrogram for diagnosis of acute rejection after heart transplantation in rats

作　　者：陈阳天[1] 陈昆[1] 李增棋[1] 廖东山[1] 余毅[1] 

机构地区：[1]福建医科大学附属第一医院心脏外科,福州350000

出　　处：《中华实验外科杂志》2013年第12期2644-2645,共2页Chinese Journal of Experimental Surgery

基　　金：福建省自然科学基金资助项目（2011J05065）

摘　　要：目的 探讨应用心肌内心电图QRS波幅诊断大鼠心脏移植术后急性排斥反应的最佳临界值.方法 建立改良Ono法大鼠腹部异位心脏移植模型,在心脏移植术中分别于供心右室流出道、左室游离壁的心肌处埋置心表起搏导线,描记心肌内心电图,测量QRS波波幅.对照组大鼠（10只）术后第7天处死,实验组大鼠（30只）分别在术后3、5、7d处死,取移植心脏进行病理检查.结果 病理结果阴性和阳性的QRS波幅分别为（94.4±4.6）％、（76.2±10.5）％,两者差异有统计学意义（P ＜0.05）;QRS波幅的受试者工作特征（ROC）曲线下面积为0.958,在最佳分割点90％的灵敏度为90.5％,特异度为88.9％,阳性预测值为95％,阴性预测值为80％,符合率为90％.结论 QRS波幅是诊断大鼠心脏移植术后急性排斥反应可靠性较高的指标,在缺乏心肌活检条件时,可以作为诊断急性排斥反应的指标.Objective To determine the threshold value of QRS amplitude in surveillance of allograft rejection after heart transplantation in rats.Methods Forty rats underwent heterotopic heart transplantations.Intramyocardial electrogram （IMEG） was recorded with epicardiac pacing leads fixed at the right ventricular outflow tract and left ventricular free wall.QRS amplitude values were detcted daily in these 10 syngeneic and 30 allogeneic transplants.Syngeneic transplants were sacrificed on 7th postoperative day and allogeneic tansplants were sacrificed on 3rd,5th and 7th postoperative day.Respectively,histopathologic studies were performed at the same time.Results QRS amplitude differed singificantly between different histopathologic outcomes （P ＜ 0.05）,（94.4 ± 4.6） ％ in negative and （76.2 ± 10.5） ％in positive.Area under receiver operating characteristic （ROC） curve of QRS amplitude was 0.958.At the best cutoff point of 90％ （≤90％ considered positive）,QRS amplitude had a sensitivity 90.5％,specificity 88.9％,positive predictive value 95％,and negative predictive value 80％,respectively.Conclusion QRS amplitude is a reliable parameter to detect allograft rejection after heart transplantation in rats.Having rather good diagnostic value,QRS amplitude may be used as a replacement for EMB at the best cutoff point when EMB can＇t be performed.

关 键 词：心肌内心电图 心脏移植 急性排斥反应 

分 类 号：R654.2[医药卫生—外科学]