肌钙蛋白Ⅰ和心肌灌注对无冠状动脉粥样硬化性心脏病的肥厚型心肌病的临床意义  

Significance of Cardiac Troponin Ⅰ and Myocardial Perfusion and Viability in Hypertrophic Cardiomyopathy Patients without Coronary Heart Disease

作　　者：孙筱璐[1] 王东[1] 康连鸣[1] 蒋文[1] 孙晓昕[2] 王继征[3] 宋雷[1,3] SUN Xiao-lu;WANG Dong;KANG Lian-ming;JIANG Wen;SUN Xiao-xin;WANG Ji-zheng;SONG Lei(Department of nuclear medicine, State Key Laboratory of Cardiovaseular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院核医学科,北京市100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室,北京市100037

出　　处：《中国分子心脏病学杂志》2018年第1期2360-2363,共4页Molecular Cardiology of China

基　　金：工程中国医学科学院医学与健康科技创新工程(2016-I2M-1-002)

摘　　要：目的探讨无冠状动脉粥样硬化性心脏病(冠心病)的肥厚型心肌病患者心肌肌钙蛋白I(c Tn I)水平与磁共振心肌灌注延迟显像(LGE)及核素心肌灌注/代谢显像(PET-CT)的关系。方法连续入选自2016年5月至2017年4月在阜外医院进行住院治疗的无冠心病的肥厚型心肌病患者共80例。根据c Tn I水平分为c Tn I正常组和c Tn I异常组两组进行比较。结果所有患者的平均年龄47.3±14.3岁,男性占全部患者的68.7%,c Tn I异常的患者占57.5%。c Tn I异常组与c Tn I正常组相比室壁最厚厚度更厚(22.6±6.3 mm vs.20.6±5.8 m m,P=0.043),总胆红素水平(19.7μmol/L vs.15.6μmol/L,P=0.011)更高、超敏C反应蛋白(2.6 mg/L vs.1.0mg/L,P<0.001)及大内皮素-1(5.1 pmol/L vs.4.0 pmol/L,P=0.039)均偏高,PET-CT心肌代谢显像提示非节段性、散在的放射性核素分布稀疏、缺损者更多见(22.2%vs.7.2%,P=0.016),LGE阳性率更高(54.3%vs.32.4%,P=0.042),而NT-pro BNP水平及是否合并梗阻在两组间未发现差异。结论 c Tn I水平及核素心肌灌注/代谢显像有利于对无冠心病的肥厚型心肌病患者的临床评价和管理;c Tn I水平升高与疾病的严重程度和心肌灌注不足可能相关,未来的研究应该进一步评估c Tn I和心肌灌注/代谢与临床预后的关系,以期能进一步改善危险分层。Objective Little report is available on myocardial viability in patients with Hypertrophic Cardiomyopathy（HCM） without coronary atherosclerotic heart disease（CAD）.The associations between circulating levels of cardiac troponin I（c Tn I）, fibrosis as assessed by late gadolinium enhancement（LGE）, the myocardial perfusion and viability using 99 m TC-MIBI single photon emission computed tomography（SPECT） and 18 F-FDG positron emission tomography（PET） have not been established in HCM patients without CAD.We investigated the role of cardiac troponin I（c Tn I） and to identify myocardial perfusion and viability in HCM patients without CAD. Methods We performed clinical evaluation including measurements of c Tn I and 99 m TC-MIBI myocardial perfusion SPECT and 18 F-FDG myocardial metabolism PET in 80 consecutive patients with HCM withouot CAD from May 2016 to April 2017 in Fuwai hospital. A comprehensive cardiac evaluation were compared between patients with normal and increased c TNI levels. Results Of 80 HCM patients withouot CAD, 68.7% were males, mean age at 47.3±14.3 years, 46（57.5%） showed abnormal c Tn I values（ 0.032 ng/ml）. Patients with elevated c Tn I levels had greater maximum wall thickness（22.6 ± 6.3 mm vs 20.6 ± 5.8 mm, P=0.043）, higher serum total bilirubin（19.7±12.1μmol/L vs 15.6±3.8 μmol/L, P=0.011）, higher hs-CRP（2.6 mg/L vs 1.0 mg/L, P=0.000） and ET-1（5.1 pmol/L vs 4.0 pmol/L, P=0.039）,more often had perfusion abnormalities with mild and not segmental distribution（22.2% vs 7.2%, P=0.016） and more LGE-positive（54.3% vs 32.4%, P=0.042）, whereas NT-pro BNP levels and with or without obstructive did not differ between the two groups. Conclusions Routine measurement of c TNI and the myocardial perfusion and viability therefore may be useful in the clinical evaluation and management of patients with HCM without CAD. Elevated c Tn I levels in HCM patients without CAD are associated with disease severity and, potentially, with poor myocardial p

关 键 词：肥厚型心肌病 PET-CT 心肌肌钙蛋白 钆延迟强化 

分 类 号：R541.4[医药卫生—心血管疾病]