摘要
目的通过心血管磁共振来描述和识别亚临床系统性硬化症原发性心脏受累(SSc-PHI),明确疾病严重程度及血清生物标志物与亚临床SSc-PHI是否存在相关性。方法回顾性分析2022年1月至12月在解放军总医院住院的系统性硬化症(SSc)患者。共有26例无心血管疾病或肺动脉高压病史的SSc患者进行了3 T增强心血管磁共振检查,测量包括native T_(1)、细胞外容积(ECV)、晚期钆增强(LGE)、T_(2)mapping和左室容积功能,以及肌钙蛋白T和N端脑钠肽前体。结果在26例患者中有13例(50.0%)患者观察到LGE,提示局灶性纤维化,弥漫型SSc组的T_(2)mapping显著高于局限型SSc(P=0.009)。所有患者的左室容积和功能均在正常范围内,但弥漫型SSc组的左室收缩末期容积显著高于局限型SSc组(P=0.021)。有LGE局灶性纤维化患者的改良Rodnan皮肤评分(mRSS)显著升高(P=0.019)。logistic回归分析证实了mRSS和LGE之间的关联(OR=1.224,P=0.037)。多因素分析中,T_(2)mapping与病程呈负相关,与弥漫型SSc及指端溃疡相关(R 2=0.711,P=0.018,P=0.013,P=0.030),肌钙蛋白T和T_(2)mapping存在相关性(r=0.555,P=0.049)。结论亚临床SSc-PHI的特征是心肌弥漫性和局灶性纤维化,但保留心肌收缩功能。亚临床SSc-PHI与肌钙蛋白T、SSc疾病严重程度和复杂的周围血管病变有关。这些数据为识别有SSc-PHI风险的个体提供了信息。
Objectives Primary cardiac involvement(SSc-PHI)in systemic sclerosis is an important prognostic factor.We aimed to characterize and identify subclinical SSc-PHI using cardiovascular MRI to determine whether disease severity and serum biomarkers are associated with subclinical SSc-PHI.Methods A total of 26 patients with SSc who had no history of cardiovascular disease or pulmonary hypertension underwent 3 T-enhanced cardiovascular MRI.Measurements included native T_(1),extracellular volume,advanced gadolinium enhancement,T_(2)mapping,and left ventricular volume function.Troponin T and N telencephalic natriuretic peptide precursors were also determined.Results LGE was observed in 13 of 26 patients(50.0%),suggesting focal fibrosis,and T_(2)mapping was significantly higher in the dcSSc group than in the lcSSc group(P=0.009).Left ventricular volume and function were within the normal range in all patients,but final systolic left ventricular volume was significantly higher in dcSSc than in lcSSc(P=0.021).The modified Rodnan skin score(mRSS)was significantly higher in patients with LGE focal fibrosis(P=0.019).Logistic regression analysis confirmed the association between mRSS and LGE(OR=1.224,P=0.037).In multivariate analysis,T_(2)mapping was negatively correlated with disease course,and was correlated with dcSSc and fingertip ulcer(R 2=0.711,P=0.018,P=0.013,P=0.030).Troponin T was correlated with T_(2)mapping(r=0.555,P=0.049).Conclusions Subclinical SSc-PHI is characterized by diffuse and focal myocardial fibrosis,but preserves myocardial systolic function.Subclinical SSC-Phi is associated with TNT,SSc disease severity,and complex peripheral vascular disease.These data provide information for identifying individuals at risk of SSc-PHI.
作者
赵征
赵亚男
金京玉
杨金水
朱剑
李涛
Zhao Zheng;Zhao Ya'nan;Jin Jingyu;Yang Jinshui;Zhu Jian;Li Tao(Department of Rheumatology and Immunology,the First Medical Center of the Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,the First Medical Center of the Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华内科杂志》
CAS
CSCD
北大核心
2024年第2期176-182,共7页
Chinese Journal of Internal Medicine
关键词
硬皮病
系统性
磁共振成像
心脏纤维化
Scleroderma,systemic
Magnetic resonance imaging
Myocardial fibrosis
作者简介
通信作者:李涛,Email:litaofeivip@163.com。
