心脏磁共振诊断心肌挫伤的应用价值  

Value of cardiac magnetic resonance in the diagnosis of myocardial contusion

作　　者：缪青松 丛德刚[2] 刘克元 丁建平[3] 王付言[3] Miao Qingsong;Cong Degang;Liu Keyuan;Ding Jianping;Wang Fuyan(Faculty of Medicine,Hangzhou Normal University,Hangzhou 311121,China;Department of Cardiothoracic Surgery,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Radiology,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学医学部,杭州311121 [2]杭州师范大学附属医院心胸外科,杭州310015 [3]杭州师范大学附属医院放射科,杭州310015

出　　处：《中华创伤杂志》2022年第1期54-60,共7页Chinese Journal of Trauma

基　　金：浙江省医药卫生科技计划(2019KY132)。

摘　　要：目的探讨心脏磁共振(CMR)诊断心肌挫伤的应用价值。方法采用病例对照研究分析2018年9月至2021年1月杭州师范大学附属医院收治的42例钝性胸部损伤患者的临床资料,其中男24例,女18例;年龄23~66岁[(44.2±10.9)岁]。根据临床心肌挫伤诊断标准(心肌肌钙蛋白Ⅰ>0.06 ng/ml)分为心肌挫伤组(20例)和心肌未挫伤组(22例)。患者入院后7 d内行CMR检查,24 h内行心电图(ECG)和经胸超声心动图(TTE)检查,比较两组CMR、ECG和TTE异常改变的差异。采用受试者工作特征(ROC)曲线比较CMR、ECG和TTE对心肌挫伤诊断的效能,计算CMR、ECG和TTE的曲线下面积(AUC)、灵敏度、特异度、阳性预测值和Youden指数。结果心肌挫伤组CMR异常15例(75%),心肌未挫伤组CMR异常2例(9%)(P<0.01);CMR异常改变主要表现为心肌水肿、缺血或出血,位于左心室12例(71%),右心室3例(18%),室间隔2例(12%)。心肌挫伤组ECG异常12例(60%),心肌未挫伤组异常7例(32%)(P>0.05)。ECG异常改变中窦性心动过速或过缓8例(42%),ST-T改变5例(26%),房性早搏3例(16%),束支阻滞2例(11%),频发室性早搏1例(5%)。心肌挫伤组TTE异常10例(50%),心肌未挫伤组异常9例(41%)(P>0.05)。TTE异常改变中左心舒张功能减低12例(63%),室壁运动异常7例(37%)。CMR、ECG、TTE诊断心肌挫伤的AUC分别为0.83(95%CI 0.70~0.96)、0.64(95%CI 0.47~0.81)、0.55(95%CI 0.37~0.72),灵敏度分别为75.0%、60.0%、50.0%,特异度分别为91.0%、68.2%、59.1%,阳性预测值分别为88.2%、63.2%、52.6%,Youden指数分别为66.0、28.2、9.1。结论CMR可较为准确地诊断心肌挫伤,诊断效能优于ECG、TTE,且有较高的灵敏度和特异度,对临床诊断心肌挫伤具有重要价值。Objective To evaluate the diagnostic value of cardiac magnetic resonance(CMR)in myocardial contusion.Methods A case-control study was performed on 42 patients with blunt chest injury treated in Affiliated Hospital of Hangzhou Normal University from September 2018 to January 2021.There were 24 males and 18 females,with the age range of 23-66 years[(44.2±10.9)years].The patients were divided into myocardial contusion group(n=20)and non-myocardial contusion group(n=22)according to the clinical diagnostic criteria of myocardial contusion(cardiac troponin I>0.06 ng/ml).All the patients underwent CMR examination within 7 days after hospitalization,and eletrocardiography(ECG)as well as transthoracic echocardiography(TTE)examinations with 24 hours.Abnormal findings on CMR,ECG and TTE were compared between the two groups.The receiver operating characteristic(ROC)curve was used for the comparison of the diagnostic efficacy of CMR,ECG and TTE for myocardial contusion.The area under the curve(AUC),sensitivity,specificity,positive predictive value and Youden index of CMR,ECG and TTE were calculated,respectively.Results There were 15 patients(75%)presenting CMR abnormalities in myocardial contusion group compared to 2 patients(9%)in non-myocardial contusion group(P<0.01).CMR abnormalities mainly included myocardial oedema,ischemia or hemorrhage,which were located in the left ventricle of 12 patients(71%),right ventricle of 3(18%)and ventricular septal of 3(12%).There were 12 patients(60%)showing ECG abnormalities in myocardial contusion group compared to 7 patients(32%)in non-myocardial contusion group(P>0.05).Abnormal ECG changes included 8 patients(42%)with sinus tachycardia or bradycardia,5(26%)with ST-T changes,3(16%)with atrial premature beat,2(11%)with bundle branch block and 1(5%)with frequent premature ventricular contractions.There were 10 patients(50%)showing TTE abnormalities in myocardial contusion group compared to 9 patients(41%)in non-myocardial contusion group(P>0.05).TTE abnormalities manifested as left ventr

关 键 词：胸部损伤 心肌 挫伤 磁共振成像 心电描记术 超声心动描记术 

分 类 号：R655[医药卫生—外科学]