中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (12): 816-821.doi: 10.3969/j.issn.1671-4091.2017.012.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者心脏磁共振初始T1 mapping 表现及相关因素分析

姚理京1,孙芳2,沈洋2,刘婧2,马丽洁2,刘敏3,周亦伦4   

  1. 1厦门大学附属第一医院肾内科
    2首都医科大学附属北京朝阳医院肾内科
    3中日友好医院放射科
    4首都医科大学附属北京天坛医院肾内科
  • 收稿日期:2017-07-11 修回日期:2017-11-05 出版日期:2017-12-12 发布日期:2017-12-18
  • 通讯作者: 刘敏: mikie0763@126.com (刘敏和周亦伦为本文共同通讯作者） 周亦伦: zhouyilun2008@sina.cn E-mail:zhouyilun2008@sina.cn
  • 基金资助:

    北京市卫生系统高层次卫生技术人才培养学科骨干，2014-3-021

Features and related factors of cardiovascular magnetic resonance imaging native T1 mapping in patients on maintenance hemodialysis

  • Received:2017-07-11 Revised:2017-11-05 Online:2017-12-12 Published:2017-12-18

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摘要： 目的应用心脏磁共振(cardiovascular magnetic resonance imaging, CMRI)初始T1mapping 技术探究维持性血液透析(maintenance hemodialysis,MHD)患者的心肌纤维化病变，并探寻MHD 患者心肌纤维化病变的相关因素。方法选取32 例MHD 患者行CMRI 检查，并收集动态血压数据及各项化验结果，另选取14 例健康志愿者作为对照组，行CMRI 检查。探究两组人群心肌初始T1 值的差异，及MHD 患者初始T1 值的改变与动态血压指标、各项实验室化验结果之间是否存在相关性。结果MHD组患者心脏初始T1 值高于对照组(1208.9±90.9ms 比1134.5±28.1ms)，差异具有统计学意义(F=4.270，P=0.045)，MHD 组患者左室基底段[(1213.1 ± 89.1)ms]、室中段[(1200.6 ± 89.8)ms]、远段[(1213.1±10.3)ms]初始T1 值之间无显著性差异(F=0.186,P=0.831)。MHD 组患者心脏初始T1 值与全段甲状旁腺素水平呈正相关(r=0.418，P =0.017)，与三酰甘油水平呈负相关(r=-0.366，P=0.039)；初始T1 值与44h 平均收缩压、44h 平均舒张压、收缩压变异和舒张压变异之间均不存在线性相关关系(r1=0.204，P1=0.320；r2=0.316，P2=0.208；r3=0.259，P3=0.402；r4=0.135，P 4=0.662)。MHD 患者心脏初始T1 值与左室舒张末期容积/体表面积、左室收缩末期容积/体表面积、左室质量指数呈正相关(r1=0.528，P 1=0.014；r2=0.506，P 2=0.019；r3=0.600，P 3=0.005)，与射血分数(ejection fraction,EF)呈负相关(r=-0.551，P =0.010)，与心脏指数无线性关系(r=-0.210，P=0.357)。结论MHD 患者心肌初始T1 值较健康人高，提示其心肌纤维化程度重，初始T1 值大小与心脏结构、功能指标关联密切，全段甲状旁腺素、三酰甘油可能在MHD患者心肌纤维化的发生、发展过程中起重要作用。

关键词: 血液透析, 心脏核磁, 初始T1 mapping, 心肌纤维化

Abstract: Objective This study applies the native T1 mapping technology in cardiovascular magnetic resonance imaging (CMRI) to explore myocardial fibrosis and its related factors in maintenance hemodialysis (MHD) patients. Methods We recruited 32 MHD patients and 14 healthy individuals as the normal controls to perform CMRI examination. Ambulatory blood pressure and laboratory tests of the MHD patients were collected. The CMRI native T1 value was compared between MHD patients and controls. The correlation between native T1 value and the related factors including ambulatory blood pressure and laboratory tests was explored in MHD patients. Results The CMRI native T1 value was higher in MHD patients than in normal controls (1,208.9±90.9ms vs. 1,134.5± 28.1ms, F=4.270, P=0.045). In MHD patients, there were no signif-icant differences (F=0.186, P=0.831) between the native T1 values of left ventricular basal segment (1,213.1±89.1ms), medial segment (1,200.6±89.8ms) and distal segment (1,213.1±10.3ms). The CMRI native T1 value was positively correlated to intact parathyroid hormone (iPTH; r=0.418, P=0.017) and negatively correlated to triglycerides (r=-0.366, P=0.039), but had no linear correlations to the average systolic blood pressure in 44hours (r=0.204, P=0.320), the average diastolic blood pressure in 44 hours (r=0.316, P=0.208), systolic blood pressure variation (r=0.259, P=0.402) and diastolic blood pressure variation (r=0.135, P=0.662). The native T1 value was positively correlated to left ventricular end-diastolic volume/body surface area (LVEDV/BSA; r=0.528, P=0.014), left ventricular end systolic volume/body surface area (LVESV/BSA; r=0.506, P=0.019) and left ventricular mass index (LVMI; r=0.600, P=0.005) and negatively correlated to ejection fraction (EF; r=- 0.551, P=0.010), but had no correlation to cardiac index (CI; r=- 0.210, P=0.357). Conclusion The CMRI native T1 value was higher in MHD patients than in normal controls, suggesting that significant myocardial fibrosis is present in MHD patients. The native T1 value was closely related to heart structure and function. iPTH and triglyceride may play important roles in the presence and development of cardiac fibrosis.

Key words: Hemodialysis, Cardiovascular magnetic resonance imaging, Native T1 mapping, Myocardial fibrosis