心肌T_(1)Mapping技术用于非射血分数减低的Ⅱ型糖尿病患者的初步研究  

Preliminary Investigation of Myocardial T_(1)Mapping in TypeⅡDiabetic Patients with Preserved Ejection Fraction

作　　者：李国荣 鄢广平 龚万庆 赵献策 岳修正 张婷婷[1] LI Guorong;YAN Guangping;GONG Wanqing(The First Clinical Medical School of Three Gorges University,Yichang,Hubei Province 443000,P.R.China)

机构地区：[1]三峡大学第一临床医学院(宜昌市中心人民医院),宜昌443000

出　　处：《临床放射学杂志》2025年第2期285-293,共9页Journal of Clinical Radiology

摘　　要：目的利用心脏磁共振(CMR)定量评估非射血分数减低的Ⅱ型糖尿病患者(T2DM)左心室(LV)心肌是否存在细胞外基质(ECM)的扩增及心肌应变的异常改变,探究心肌变形和组织异常的改变与临床参数的潜在关系。方法前瞻性招募经宜昌市中心人民医院西陵院区内分泌科诊断的T2DM患者50例,其中男性28例,女性22例,平均年龄57.5岁,同时招募30名性别、年龄和体重指数与之相匹配的健康志愿者作为对照组,包括男性17名,女性13名,平均年龄56岁。采用Philips Ingenia Ambition 1.5 T磁共振扫描仪进行CMR增强和平扫检查。根据改良Look-Locker反转恢复技术获得T_(1)Mapping图,由放射科医师在离线工作站使用商业软件Cvi 42(Circle cardiovascular imaging,Calgary,Canada)对所获取CMR数据进行处理。所有图像后处理操作均按照最新的国际心脏磁共振协会指南进行,测量出左心室心肌native T_(1)值、增强后T_(1)值(post-contrast T_(1))和心肌细胞外体积分数(ECV),利用心脏磁共振特征追踪技术(CMR-FT)对心肌应力进行定量评估。同时系统搜集所有研究对象的临床和实验室资料。结果非射血分数减低的T2DM患者心肌native T_(1)和ECV均明显高于健康对照组[native T_(1):1050.50 ms vs.1017.50 ms,P=0.001;ECV:31.0%vs.27.0%,P<0.001],而非射血分数减低的T2DM患者纵向舒张期峰值应变率(Longitudinal PDSR)低于健康对照组[0.94(0.81,1.16)1/s vs.1.23(1.08,1.36)1/s;P=0.003]。非射血分数减低的T2DM患者心肌native T_(1)值、ECV值与T2DM持续时间呈显著正相关(native T_(1):r=0.318、P=0.024;ECV:r=0.694、P<0.001)。结论CMR可以反映非射血分数减低的T2DM患者心肌组织结构及应力的异常改变和评估患者心肌ECM扩增程度,ECM扩增程度与T2DM持续时间呈正相关,与糖化血红蛋白(HbA1c)水平高低无关。Objective To quantitatively assess the expansion of extracellular matrix(ECM)and abnormal myocardial strain in the left ventricular(LV)myocardium of patients with typeⅡdiabetes mellitus(T2DM)without reduced ejection fraction using cardiac magnetic resonance imaging(CMR),and to investigate potential associations between changes in myocardial deformation,tissue abnormalities,and clinical parameters.Methods Fifty patients with T2DM(28 males and 22 females,with an average age of 57.5 years)and 30 healthy controls(17 males and 13 females,with an average age of 56 years)were prospectively enrolled in this study.CMR was performed using a Philips Ingenia Ambition 1.5 T magnetic resonance scanner.T_(1)Mapping was obtained using the modified Look-Locker inversion recovery technique.The acquired CMR data were processed by radiologists utilizing commercial software Cvi42(Circle cardiovascular imaging,Calgary,Canada)at an offline workstation following the latest guidelines from the International Society of Cardiac Magnetic Resonance.The native T_(1)value,post-contrast T_(1)value,and extracellular volume fraction(ECV)of the LV myocardium were measured to quantitatively evaluate myocardial stress through cardiac magnetic resonance feature tracking(CMR-FT).Simultaneously,clinical and laboratory data for all subjects were systematically collected.Results The myocardial native T_(1)and ECV in patients with T2DM without reduced ejection fraction were significantly elevated compared to healthy controls(native T_(1):1050.50 ms vs.1017.50 ms,P=0.001;ECV:1017.50ms,P=0.001).Additionally,the prevalence of abnormal values was higher in T2DM patients than in healthy controls(31.0%vs.27.0%,P<0.001).Conversely,the longitudinal peak diastolic strain rate(PDSR)was lower in T2DM patients without reduced ejection fraction when compared to healthy controls[0.94(0.81,1.16)1/s vs.1.23(1.08,l.36)l/s;P=0.003].Furthermore,within the group of T2DM patients without reduced ejection fraction,there was a positive correlation between native T_(1)and ECV

关 键 词：Ⅱ型糖尿病 细胞外基质 心肌细胞外体积分数 射血分数 心脏磁共振成像 

分 类 号：R58[医药卫生—内分泌]