可溶性致癌抑制因子2、半乳糖凝集素3联合磁共振多模态对心肌纤维化的临床研究  

Clinical study on diagnosis of myocardial fibrosis by soluble suppression of tumorigenicity 2,galectin-3 combined with magnetic resonance multimodality

作　　者：张延涛[1] 田洪森[1] 马美芳[1] Zhang Yantao;Tian Hongsen;Ma Meifang(Department of Vasculocardiology,Handan Central Hospital of Hebei Province,Hebei Handan 056000,China)

机构地区：[1]河北省邯郸市中心医院心血管内科,056000

出　　处：《中国医师进修杂志》2021年第7期655-660,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:探讨可溶性致癌抑制因子2(SST2)、半乳糖凝集素3联合磁共振多模态诊断心肌纤维化的应用价值。方法:回顾性分析2017年1月至2019年12月河北省邯郸市中心医院88例心肌病患者(心肌病组)的临床资料,并选同期健康体检者100例作为对照组。心肌病患者根据心脏磁共振成像(CMRI)-延迟钆增强(LGE)检查结果分为LGE阳性和LGE阴性。两组采用动态心电图评估心律异常率;记录美国纽约心脏病协会(NYHA)心功能分级;超声心动图检测左室射血分数(LVEF)和左室舒张末期内径(LVEDD);酶联免疫吸附试验(ELISA)法检测SST2、半乳糖凝集素3和N末端脑钠肽前体(NT-proBNP)。绘制受试者工作特征(ROC)曲线,分析SST2和半乳糖凝集素3预测心肌病患者发生心肌纤维化的效能。结果:88例心肌病患者CMRI-LGE检查结果显示,LGE阳性42例,LGE阴性46例。心肌病组心律异常率、LVEDD、SST2和半乳糖凝集素3明显高于对照组[67.05%(59/88)比2.00%(2/100)、(46.55±5.99)mm比(27.92±2.05)mm、(61.83±10.57)μg/L比(24.99±7.69)μg/L和(18.65±3.39)μg/L比(7.12±1.33)μg/L],LVEF明显低于对照组[(55.11±8.36)%比(68.83±9.45)%],差异有统计学意义(P<0.01)。LGE阳性患者心律异常率、NYHA心功能分级、LVEDD、SST2和半乳糖凝集素3明显高于LGE阴性患者[88.10%(37/42)比47.83%(22/46)、(3.10±0.53)级比(2.11±0.61)级、(48.88±5.95)mm比(44.41±5.24)mm、(65.58±11.73)μg/L比(58.40±8.10)μg/L和(21.00±2.72)μg/L比(16.51±2.39)μg/L],LVEF明显低于LGE阴性患者[(52.15±8.23)%比(57.82±7.60)%],差异有统计学意义(P<0.01)。ROC曲线分析结果显示,血清SST2和半乳糖凝集素3预测心肌病患者发生心肌纤维化的最佳临界值分别为65.07μg/L和18.46μg/L,曲线下面积分别为0.714(95%CI 0.604~0.825,P=0.001)和0.894(95%CI 0.828~0.960,P=0.001),灵敏度分别为61.9%和85.7%,特异度分别为80.4%和82.6%。结论:磁共振多模态对心肌纤维化有良好的检测能力,血清SST2�Objective:To explore the application value of soluble tumor suppressor 2(SST2),galectin-3 combined with magnetic resonance multimodality in the diagnosis of myocardial fibrosis.Methods:The clinical data of 88 patients with cardiomyopathy from January 2017 to December 2019 in Handan Central Hospital of Hebei Province were retrospectively analyzed as the experimental group,and 100 healthy people in the same period were selected as the control group.According to the results of cardiac magnetic resonance imaging(CMRI)-late gadolinium enhanced(LGE),the patients with cardiomyopathy were divided into LGE positive and LGE negative.The arrhythmia rate was evaluated by ambulatory electrocardiogram.The New York Heart Association(NYHA)cardiac function grade was recorded.The left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)were detected by echocardiography.The SST2,galectin-3 and N-terminal pro-brain natriuretic peptide(NT-proBNP)were detected by enzyme-linked immunosorbent assay(ELISA).The receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of SST2 and Galectin-3 in predicting myocardial fibrosis in patients with cardiomyopathy.Results:CMRI-LGE results of 88 patients with cardiomyopathy showed that LGE was positive in 42 cases and negative in 46 cases.The arrhythmia rate,LVEDD,SST2 and galectin-3 in experimental group were significantly higher than those in control group:67.05%(59/88)vs.2.00%(2/100),(46.55±5.99)mm vs.(27.92±2.05)mm,(61.83±10.57)μg/L vs.(24.99±7.69)μg/L and(18.65±3.39)μg/L vs.(7.12±1.33)μg/L,the LVEF was significantly lower than that in control group:(55.11±8.36)%vs.(68.83±9.45)%,and there were statistical differences(P<0.01).The arrhythmia rate,NYHA cardiac function grade,LVEDD,SST2 and galectin-3 in patients with LGE positive were significantly higher than those in patients with LGE negative:88.10%(37/42)vs.47.83%(22/46),(3.10±0.53)grade vs.(2.11±0.61)grade,(48.88±5.95)mm vs.(44.41±5.24)mm,(65.58±11.73)μg/L vs.(58.40±8.10)

关 键 词：半乳糖凝集素3 纤维化 可溶性致癌抑制因子2 磁共振多模态 

分 类 号：R542.23[医药卫生—心血管疾病]