摘要
目的 探讨心脏磁共振(CMR)增强扫描分析获得性免疫缺陷综合征(简称艾滋病)患者心肌组织和心功能改变情况.方法 选择艾滋病患者56例(观察组),其中男性42例,女性14例;年龄21.2～57.6岁,平均年龄40.50岁;身体质量指数18.3～26.1 kg/m2,平均身体质量指数22.21 kg/m2.同时选择人类免疫缺陷病毒(HIV)感染患者56例(对照组),其中男性40例,女性16例;年龄20.5～59.4岁,平均年龄39.69岁;身体质量指数18.0～25.8 kg/m2,平均身体质量指数22.15 kg/m2.两组均给予CMR增强扫描,比较各组患者CMR检查参数差异.结果 观察组心脏损伤发生率为37.50％,高于对照组(P＜0.05).观察组左心室心肌质量(LVM)、心肌灌注曲线下面积、相对峰值信号强度为(80.15±11.43)g、(48.82±5.12)％、(40.05±5.09)％,明显低于对照组(P＜0.05),而左心室重构指数(LVRI)、达峰时间和MRI延迟强化成像(LGE)占左心室质量比例分别为1.51±0.12、(40.84±6.18)s和(3.72±0.96)％,明显高于对照组(P＜0.05);观察组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室搏出量(LVSV)、左心室射血分数(LVEF)、右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心室搏出量(RVSV)和右心室射血分数(RVEF)与对照组比较,差异无统计学意义(P＞0.05).观察组不同病程患者LVEDV、LVESV、LVSV、LVEF、LVM、LVRI、RVEDV、RVESV、RVSV和RVEF比较,差异无统计学意义(P＞0.05);观察组病程≥12个月患者心肌灌注曲线下面积、相对峰值信号强度分别为(47.31±5.02)％、(37.91±5.12)％,明显低于病程＜12个月患者(P＜0.05),而达峰时间、LGE占左心室质量比例分别为(42.85±5.93)s、(3.92±0.93)％,明显高于病程＜12个月患者(P＜0.05).观察组不同病毒载量患者LVEDV、LVESV、LVSV、LVEF、LVM、LVRI、RVEDV、RVESV、RVSV、RVEF、心肌灌注曲线下面积、相对峰值信号强度、达峰时间和LGE占左心室质量比例比较,差异无统计学意义(P＞0.05).结论 艾滋病患者心肌组织和心功能有所改变,CMR检查能早期评估患者心肌损伤情况.
Abstract
Objective To explore the changes of myocardial tissue and cardiac function in patients with acquired immunodefi-ciency syndrome(AIDS)by cardiac magnetic resonance(CMR)enhanced scanning.Methods A total of 56 patients with AIDS were enrolled(observation group),which included 42 males and 14 females,aged 21.2-57.6 years old with mean age of 40.50 years old;body mass index(BMI)was 18.3-26.1 kg/m2 with mean BMI of 22.21 kg/m2.Meantime,56 patients with human immunodeficiency virus(HIV)infection were set as control group,which included 40 males and 16 females,aged 20.5-59.4 years old with mean age of 39.69 years old;BMI was 18.0-25.8 kg/m2 with mean BMI of 22.15 kg/m2.All of them performed CMR enhanced scanning,and the differences in CMR examination parameters between 2 groups were compared.Results The incidence of cardiac injury of observation group was 37.50％,which was higher than that of control group(P＜0.05).The left ventricular myocardial mass(LVM),area under myocardial perfusion curve,and relative peak signal intensity of observation group were(80.15±11.43)g,(48.82±5.12)％,and(40.05±5.09)％,which were significantly lower than those of control group(P＜0.05).The left ventricular remodeling index(LVRI),time to peak and proportion of late gadolinium en-hancement(LGE)in left ventricular mass were 1.51±0.12,(40.84±6.18)seconds and(3.72±0.96)％,respectively,which were significantly higher than those of control group(P＜0.05).In addition,there was no significant difference in left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular stroke volume(LVSV),left ventricu-lar ejection fraction(LVEF),right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),right ventricular stroke volume(RVSV)and right ventricular ejection fraction(RVEF)between 2 groups(P＞0.05).There was no significant difference in LVEDV,LVESV,LVSV,LVEF,LVM,LVRI,RVEDV,RVESV,RVSV and RVEF for pa-tients with different disease course of observation group(P＞0.05).In observation group,the area under myocardial perfusion curve and relative peak signal intensity in patients with disease course≥12 months were(47.31±5.02)％and(37.91±5.12)％,respectively,which were significantly lower than those in patients with disease course＜12 months(P＜0.05).Nevertheless in patients with disease course≥12 months,the time to peak and proportion of LGE in left ventricular mass were(42.85±5.93)seconds and(3.92±0.93)％,respectively,which were significantly higher than those in patients with disease course＜12 months(P＜0.05).There were no significant differences in LVEDV,LVESV,LVSV,LVEF,LVM,LVRI,RVEDV,RVESV,RVSV,RVEF,area under myocardial perfusion curve,relative peak signal intensity,time to peak and LGE to left ventricular mass ratio among patients with different viral loads of observation group(P＞0.05).Conclusion It is demonstrated that myocar-dial tissue and cardiac function of patients with AIDS are changed,and CMR can assess the myocardial injury of patients in early stage.
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