维持性血液透析患者心脏磁共振初始T1 mapping表现及相关因素分析  

Features and related factors of cardiovascular magnetic resonance imaging native T1 mapping in patients on maintenance hemodialysis

作　　者：姚理京 孙芳[2] 沈洋[2] 刘婧[2] 马丽洁[2] 刘敏[3] 周亦伦[4] 

机构地区：[1]厦门大学附属第一医院肾内科,厦门361001 [2]首都医科大学附属北京朝阳医院肾内科,北京100020 [3]中日友好医院放射科,北京100029 [4]首都医科大学附属北京天坛医院肾内科,北京100050

出　　处：《中国血液净化》2017年第12期816-821,共6页Chinese Journal of Blood Purification

基　　金：基金项目:北京市卫生系统高层次卫生技术人才培养学科骨干;2014-3-021

摘　　要：目的应用心脏磁共振(cardiovascular magnetic resonance imaging,CMRI)初始T1mapping技术探究维持性血液透析(maintenance hemodialysis,MHD)患者的心肌纤维化病变,并探寻MHD患者心肌纤维化病变的相关因素。方法选取32例MHD患者行CMRI检查,并收集动态血压数据及各项化验结果,另选取14例健康志愿者作为对照组,行CMRI检查。探究两组人群心肌初始T1值的差异,及MHD患者初始T1值的改变与动态血压指标、各项实验室化验结果之间是否存在相关性。结果 MHD组患者心脏初始T1值高于对照组(1208.9±90.9ms比1134.5±28.1ms),差异具有统计学意义(F=4.270,P=0.045),MHD组患者左室基底段[(1213.1±89.1)ms]、室中段[(1200.6±89.8)ms]、远段[(1213.1±10.3)ms]初始T1值之间无显著性差异(F=0.186,P=0.831)。MHD组患者心脏初始T1值与全段甲状旁腺素水平呈正相关(r=0.418,P=0.017),与三酰甘油水平呈负相关(r=-0.366,P=0.039);初始T1值与44h平均收缩压、44h平均舒张压、收缩压变异和舒张压变异之间均不存在线性相关关系(r_1=0.204,P_1=0.320;r_2=0.316,P_2=0.208;r_3=0.259,P_3=0.402;r_4=0.135,P_4=0.662)。MHD患者心脏初始T1值与左室舒张末期容积/体表面积、左室收缩末期容积/体表面积、左室质量指数呈正相关(r_1=0.528,P_1=0.014;r_2=0.506,P_2=0.019;r_3=0.600,P_3=0.005),与射血分数(ejection fraction,EF)呈负相关(r=-0.551,P=0.010),与心脏指数无线性关系(r=-0.210,P=0.357)。结论 MHD患者心肌初始T1值较健康人高,提示其心肌纤维化程度重,初始T1值大小与心脏结构、功能指标关联密切,全段甲状旁腺素、三酰甘油可能在MHD患者心肌纤维化的发生、发展过程中起重要作用。Objective This study applies the native T1 mapping technology in cardiovascular magnet-ic resonance imaging （CMRI） to explore myocardial fibrosis and its related factors in maintenance hemodialy-sis （MHD） patients. Methods We recruited 32 MHD patients and 14 healthy individuals as the normal con-trols to perform CMRI examination. Ambulatory blood pressure and laboratory tests of the MHD patients were collected. The CMRI native T1 value was compared between MHD patients and controls. The correla-tion between native T1 value and the related factors including ambulatory blood pressure and laboratory tests was explored in MHD patients. Results The CMRI native T1 value was higher in MHD patients than in nor-mal controls （1,208.9＆#177;90.9ms vs. 1,134.5＆#177;28.1ms, F=4.270, P=0.045）. In MHD patients, there were no signif-Chin J Blood Purif,December,2017,Vol.16,No.12 icant differences （F=0.186, P=0.831） between the native T1 values of left ventricular basal segment （1,213.1＆#177; 89.1ms）, medial segment （1,200.6＆#177;89.8ms） and distal segment （1,213.1＆#177;10.3ms）. The CMRI native T1 value was positively correlated to intact parathyroid hormone （iPTH;r=0.418, P=0.017） and negatively correlated to triglycerides （r=-0.366, P=0.039）, but had no linear correlations to the average systolic blood pressure in 44 hours （r=0.204, P=0.320）, the average diastolic blood pressure in 44 hours （r=0.316, P=0.208）, systolic blood pressure variation （r=0.259, P=0.402） and diastolic blood pressure variation （r=0.135, P=0.662）. The native T1 value was positively correlated to left ventricular end-diastolic volume/body surface area （LVEDV/BSA;r=0.528, P=0.014）, left ventricular end systolic volume/body surface area （LVESV/BSA; r=0.506, P=0.019） and left ventricular mass index （LVMI;r=0.600, P=0.005） and negatively correlated to ejection fraction （EF;r=-0.551, P=0.010）, but had no correlation to cardiac index （CI; r=-0.210, P=0.357）. Conclusion The CMRI nativ

关 键 词：血液透析 心脏核磁 初始T1 MAPPING 心肌纤维化 

分 类 号：R318.16[医药卫生—生物医学工程]