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| ST段抬高型心肌梗死心肌损伤标志物与心功能、梗死容积及再灌注损伤的相关性分析 |
| 王诗渝1,钱贤灵1,吴雅丽1,任道元2,金航1,曾蒙苏1,钱菊英2,陈铟铟1* |
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(1. 复旦大学附属中山医院放射科, 上海 200030;
2. 复旦大学附属中山医院心内科, 上海 200030
*通信作者) |
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| 摘要: |
| 目的 评估ST段抬高型心肌梗死患者心肌损伤标志物与心功能、梗死容积及再灌注损伤的相关性。方法 连续入组复旦大学附属中山医院2022年9月至2023年12月53例急性ST段抬高型心肌梗死患者，根据经皮冠状动脉介入术后4～7 d心脏磁共振检查结果分为心肌内出血（IMH）组（33例）和非IMH组（19例）。分析两组心脏磁共振参数及不同时间点心肌损伤标志物水平的差异及相关性，采用ROC曲线评估不同时间点心肌损伤标志物对IMH的诊断价值。结果 与非IMH组相比，IMH组的左心室射血分数减低［（47.25±8.50）% vs （55.08±9.01）%，P＝0.003］，梗死容积百分比较高［（36.82±13.33）% vs （19.73±10.90）%，P＜0.001］。在IMH患者中，IMH容积百分比与左心室射血分数呈负相关（rs＝－0.640，P＜0.001）。经皮冠状动脉介入术后即刻肌钙蛋白T对IMH有良好的诊断效能（AUC＝0.890，P＜0.001），且与左心室射血分数呈负相关（rs＝－0.453，P＜0.01）、与心肌梗死容积百分比和IMH容积百分比呈正相关（rs＝0.540，P＜0.01；rs＝0.773，P＜0.01）。结论 IMH可导致更严重的心肌梗死且对左心室收缩功能有短期不良影响。心肌损伤标志物可用于判断ST段抬高型心肌梗死患者经皮冠状动脉介入术后IMH的发生情况，更高的心肌损伤标志物水平预示患者有更差的心功能、更大的梗死面积及更严重的再灌注损伤。 |
| 关键词: 急性ST段抬高型心肌梗死 缺血再灌注损伤 心肌内出血 心脏磁共振 心肌细胞损伤标志物 |
| DOI：10.16781/j.CN31-2187/R.20240140 |
| 投稿时间：2024-02-28修订日期：2024-05-07 |
| 基金项目:福建省科技厅自然科学基金项目（2022J05333），“申康-联影联合科研发展计划”（临床研究与转化方向）项目（SKLY2022CRT201），上海市卫生健康委员会科研课题（202040349），上海市浦江人才计划（2lPJD012）. |
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| Correlation analyses of cardiomyocyte injury markers with cardiac function, infarct volume and reperfusion injury after ST segment elevation myocardial infarction |
| WANG Shiyu1,QIAN Xianling1,WU Yali1,REN Daoyuan2,JIN Hang1,ZENG Mengsu1,QIAN Juying2,CHEN Yinyin1* |
(1. Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200030, China;
2. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200030, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the correlations between cardiomyocyte injury markers and cardiac function, infarct volume and reperfusion injury in patients with ST segment elevation myocardial infarction (STEMI). Methods A total of 53 patients with acute STEMI were enrolled from Zhongshan Hospital of Fudan University from Sep. 2022 to Dec. 2023. Cardiac magnetic resonance (CMR) was done 4 to 7 d after percutaneous coronary intervention (PCI). The patients were divided into intramyocardial hemorrhage (IMH) group (33 cases) and non-IMH group (19 cases). The differences and correlations of CMR parameters and cardiomyocyte injury markers were analyzed between the 2 groups at different time points. The diagnostic value of cardiomyocyte injury markers at different time points for IMH was evaluated by receiver operating characteristic curve. Results Compared with the non-IMH group, the left ventricular ejection fraction of the IMH group was significantly decreased (［47.25±8.50］% vs ［55.08±9.01］%, P＝0.003), and the infarct volume percentage was significantly higher (［36.82±13.33］% vs ［19.73±10.90］%, P＜0.001). There was a negative correlation between IMH volume percentage and left ventricular ejection fraction in the IMH patients (rs＝－0.640, P＜0.001). Cardiac troponin T after PCI immediately had a good effect for diagnosing IMH (area under curve was 0.890, P＜0.001), and it was negatively correlated with left ventricular ejection fraction (rs＝－0.453, P＜0.01) and positively correlated with infarct volume percentage and IMH volume percentage (rs＝0.540, P＜0.01; rs＝0.773, P＜0.01). Conclusion IMH can lead to more severe myocardial infarction and has short-term adverse effects on left ventricular systolic function. Cardiomyocyte injury markers may provide a convenient way to detect IMH in STEMI patients after PCI. Higher cardiomyocyte injury markers indicate worse cardiac function, larger infarct volume and more severe reperfusion injury. |
| Key words: acute ST segment elevation myocardial infarction ischemia-reperfusion injury intramyocardial hemorrhage cardiac magnetic resonance cardiomyocyte injury markers |
