心脏磁共振评估强直性肌营养不良1型患者心肌纤维化的临床价值  

Evaluation of myocardial fibrosis by cardiac magnetic resonance imaging in patient with myotonic dystrophy type 1

作　　者：黄少华[1] 梁宗辉[1] 童欢 管雪妮 郭瑛 张雁[1] 曹宾[1] 孙育民[1] HUANG Shaohua;LIANG Zonghui;TONG Huan;GUAN Xueni;GUO Ying;ZHANG Yan;CAO Bin;SUN Yumin(Department of Cardiology,Jing'an District Centre Hospital of Shanghai,Shanghai 200040,China)

机构地区：[1]复旦大学附属上海市静安区中心医院心内科,上海200040

出　　处：《诊断学理论与实践》2021年第4期362-366,共5页Journal of Diagnostics Concepts & Practice

基　　金：上海市静安区卫生和计划生育委员会医学科研课题(2016MS04)。

摘　　要：目的:对强直性肌营养不良1型(myotonic dystrophy type 1,DM1)患者进行心脏磁共振(cardiac magnetic resonance,CMR)检查,观察其心肌纤维化的发生情况,分析CMR及心电图检查在DM1患者心脏风险评估中的价值。方法:收集14例经基因明确诊断的DM1患者,予同期行CMR、心电图、动态心电图检查。根据其心电图或动态心电图是否发现异常,将患者分为心电图正常组和心电图异常组,以CMR检查中观察到钆剂延迟强化(late gadolinium enhancement,LGE)作为诊断标准,判断其是否存在心肌纤维化,并比较心电图正常组与异常组间的心肌纤维化发生情况。结果:14例DM1患者经CMR检查,其中有5例被检出心肌纤维化,检出率为5/14。与无心肌纤维化的患者相比,存在心肌纤维化的DM1患者的左心室质量指数[(47.1±5.4)g/m^(2)比(40.2±3.4)g/m^(2),P=0.012]、左室收缩末期容积指数[(31.L5±5.5)mL/m^(2)比(25.8±2.8)mL/m^(2),P=0.024]、左房容积指数[(43.8±7.1)mL/m^(2)比(34.3±7.4)mL/m^(2),P=0.037]均较高,而左室射血分数(52.2%±11.1%比63.9%±5.3%,P=0.019)较低,心功能明显下降。心电图正常组(5例)与异常组(9例)间比较,CMR检出异常率差异有统计学意义(7/9比1/5,P=0.036),但心肌纤维化发生率差异无统计学意义(4/9比1/5,P=0.36)。结论:DM1可累及心肌导致心肌纤维化,且常规心电图筛查结果正常的患者并不能完全排除心肌纤维化,需要加行CMR检查以明确其是否存在心肌纤维化。Objective:To evaluate myocardial fibrosis by cardiac magnetic resonance(CMR)in the patients with myotonic dystrophy type 1(DM1),and compare the value of CMR and ECG.Methods:A total of 14 patients with genetically conformed DM1 were included,and were performed CMR,electrocardiogram and dynamic electrocardiogram.Myocardial fibrosis was defined as presence of late gadolinium enhancement(LGE)in CMR.According to the results of ECG and/or dynamic ECG,the patients with DM1 were divided into normal ECG and abnormal ECG groups,and the CMR results were compared between two groups.Results:CMR examination showed that the detection rate of myocardial fibrosis in DM1 patients was 35.7%(5 out of 14).Compared with those without myocardial fibrosis,the patients with myocardial fibrosis had higher left ventricular mass index[(47.1±5.4)g/m^(2) vs.(40.2±3.4)g/m^(2),P=0.012)],left ventricular end-systolic volume index[(31.5±5.5)mL/m^(2) vs.(25.8±2.8)mL/m^(2),P=0.024)],and left atrial volume index[(43.8±7.1)mL/m^(2) vs.(34.3±7.4)mL/m^(2),P=0.037),while had lower left ventricular ejection fraction[(52.2±11.1)%vs.(63.9±5.3)%,P=0.019].There was no correlation between the existence of myocardial fibrosis and the abnormal finding of ECG(44.4%vs.20.0%,P=0.36)in the patients with DM1,while the other abnormal incidence detected by CMR was higher in abnormal ECG group than in nor-mal ECG group(77.8%vs.20.0%,P=0.036).Conclusions:Myocardial fibrosis occurs in some patients with DM1.For the patients with DM1,ECG screening fails to predict myocardial fibrosis,while CMR is valuable.Routine cardiac assessments for DM1 patients should include both CMR and ECG.

关 键 词：强直性肌营养不良 心肌纤维化 心脏磁共振 

分 类 号：R540.41[医药卫生—心血管疾病]