河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (3): 320-325.doi: 10.3969/j.issn.1007-3205.2022.03.015

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3.0T心脏磁共振技术与病毒性心肌炎患儿心肌损伤、左心室结构关联性及对预后的影响

  

  1. 北京市石景山医院医学影像科，北京 100043
  • 出版日期:2022-03-25 发布日期:2022-04-14
  • 作者简介:李梦远（1985-），女，北京人，北京市石景山医院医师，医学硕士，从事医学影像诊断研究。
  • 基金资助:

    北京市卫生科技发展专项基金（2018-2-263）

Correlation of 3.0T cardiac magnetic resonance technique with myocardial injury and left ventricular structure and its impact on prognosis in children with viral myocarditis

  1. Department of Imaging, Beijing Shijingshan Hospital， Beijing 100043， China
  • Online:2022-03-25 Published:2022-04-14

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摘要：

目的 探究3.0T 心脏磁共振（cardiac magnetic resonance,CMR）测定T2比值、LGE范围与病毒性心肌炎（viral moycarditis，VMC）患儿心肌损伤、左心室结构关联性及对预后的影响。

方法 选取VMC患儿93例作为研究对象，均行3.0T CMR检查，根据6个月预后分为预后良好组（68例）与预后不良组（25例）。比较2组一般资料、血清肌钙蛋白T（cardiac troponin T，cTnT）、磷酸肌酸激酶同工酶（creatine kinase isoenzyme，CK-MB）、左心室结构［舒张期室间隔厚度（inter ventricular septum thickness，IVST）、舒张末容积（end diastolic volume，EDV）、收缩末容积（end systolic volume，ESV）］、CMR检查参数［T2比值、晚期钆增强（late gadolinium enhancement，LGE）范围］，分析T2比值、LGE范围与血清cTnT、CK-MB、左心室结构指标相关性及VMC患儿预后的影响因素，并评价T2比值、LGE范围单独及联合对预后的预测价值。

结果 预后不良组暴发性心肌炎、低血压、快速性心律失常、使用肾上腺素治疗比例，cTnT、CK-MB、IVST、EDV、ESV水平，T2比值、LGE范围高于预后良好组，差异有统计学意义（P＜0.05）。相关性分析结果显示，T2比值（r=0.780、0.770、0.528、0.494、0.605）、LGE范围（r=0.674、0.880、0.636、0.575、0.676）与血清cTnT、CK-MB、IVST、EDV、ESV呈正相关（P＜0.05）。Logistic回归分析结果显示，暴发性心肌炎、低血压、快速性心律失常、使用肾上腺素治疗、T2比值、LGE范围是VMC患儿预后的影响因素（P＜0.05）。T2比值、LGE范围联合预测AUC值大于单一预测（P＜0.05）。

结论 3.0T CMR技术能通过测定T2比值、LGE范围评估VMC患儿左心功能，且与心肌损伤、左心室结构密切相关，为临床病情评估及预后预测提供合理依据。

关键词: 心肌炎, 磁共振成像, 预后

Abstract:

Objective To explore the correlation of T2 ratio and LGE range measured by 3.0T cardiac magnetic resonance(CMR) with myocardial injury and left ventricular structure in children with viral myocarditis(VMC) and their impact on prognosis.

Methods A total of 93 children with VMC were selected as the research subjects, and all underwent 3.0T CMR examination. According to the 6-month prognosis, they were divided into good prognosis group(n=68) and poor prognosis group(n=25). The general information, serum cardiac troponin T(cTnT), creatine kinase isoenzyme(CK-MB), left ventricular structure［inter ventricular septum thickness(IVST), end diastolic volume(EDV), end systolic volume(ESV)］, CMR examination parameters ［T2 ratio, late gadolinium enhancement(LGE) range］ were compared between two groups. The correlation between T2 ratio, LGE range and serum cTnT, CK-MB, left ventricular structure indicators, and factors affecting the prognosis of children with VMC were analyzed, and the prognostic value of T2 ratio and LGE range alone and in combination were evaluated.

Results The proportion of fulminant myocarditis, hypotension, tachyarrhythmia, and use of epinephrine, as well as serum cTnT, CK-MB levels, IVST, EDV, and ESV, T2 ratio and LGE range on admission in the poor prognosis group were greater than those in the good prognosis group(P＜0.05). Correlation analysis results showed that T2 ratio(r=0.780, 0.770, 0.528, 0.494, 0.605), and LGE range(r=0.674, 0.880, 0.636, 0.575, 0.676) were positively correlated with serum cTnT, CK-MB, IVST, EDV, and ESV(P＜0.05). Logistic regression analysis showed that fulminant myocarditis, hypotension, tachyarrhythmia, use of epinephrine, T2 ratio and LGE range were important factors influencing the prognosis of children with VMC(P＜0.05). AUC value of combined detection of T2 ratio and LGE range in prediction was higher than that of single prediction(P＜0.05).

Conclusion The 3.0T CMR technique can evaluate the left ventricular function of children with VMC by measuring the T2 ratio and LGE range, and is closely related to myocardial injury and left ventricular structure, thus providing a reasonable basis for clinical evaluation and prognosis prediction.

Key words: myocarditis, magnetic resonance imaging, prognosis

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