本文選題：擴張型心肌病 + 心臟磁共振成像��； 參考：《川北醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:采用1.5T心臟磁共振技術(shù)(CMRI)獲得心臟左心室的多項結(jié)構(gòu)和功能參數(shù)評價擴張型心肌病患者的整體心功能,初步探討1.5T MRI在心血管疾病中的應(yīng)用價值。方法:收集擴張型心肌病患者共40例及正常對照組共25例,對40例擴張型心肌病患者及25例正常對照組進行心臟磁共振檢查,或得左心室的收縮末期容積、舒張末期容積及射血分?jǐn)?shù),收縮末期內(nèi)徑及舒張末期內(nèi)徑,左心室收縮末期及舒張末期球形指數(shù)。并對擴心病患者及正常對照組進行同期血漿腦鈉肽測定和紐約心功能分級。1.比較兩組間左心室各項結(jié)構(gòu)和功能參數(shù)的改變,分析擴心病患者左心室各項結(jié)構(gòu)和功能參數(shù)間的相關(guān)性。2.利用左心室結(jié)構(gòu)及功能參數(shù)對擴心病患者的診斷價值繪制ROC曲線,評價其對擴心病診斷價值。3.分析擴心病患者左心室功能參數(shù)與紐約心功能分級的相關(guān)性。4.分析擴心病患者左心室功能參數(shù)與血漿腦鈉肽的相關(guān)性。5.分析擴心病患者血漿腦鈉肽與紐約心功能分級的相關(guān)性。6.分析擴心病患者主要的磁共振影像學(xué)表現(xiàn)。結(jié)果:1.擴心病患者左心室各項結(jié)構(gòu)和功能參數(shù)具有良好的相關(guān)性,所有結(jié)構(gòu)及功能參數(shù)對擴心病都有較高的診斷價值。2.擴心病患者左室射血分?jǐn)?shù)隨紐約心功能分級逐級升高呈降低表現(xiàn),Spearman相關(guān)性分析表明左室射血分?jǐn)?shù)與紐約心功能分級存在負(fù)相關(guān)關(guān)系(r=-0.493,P=0.001)。3.Spearman相關(guān)性分析表明擴心病患者左室射血分?jǐn)?shù)與Lg BNP存在負(fù)相關(guān)關(guān)系(r=-0.513,P=0.001)。4.Spearman相關(guān)性分析表明擴心病患者Lg BNP與紐約心功能分級存在正相關(guān)關(guān)系(r=0.568,P=0.000)。5.擴心病患者中31例(77.5%)出現(xiàn)心肌延遲強化,表現(xiàn)為左心室心內(nèi)膜下和(或)中層心肌斑片狀、線條狀強化,共計231個節(jié)段,其中發(fā)生部位以間隔壁的基底段及中段最為為主。結(jié)論:心臟磁共振成像技術(shù)是測量左心室結(jié)構(gòu)及功能參數(shù)的“金標(biāo)準(zhǔn)”,應(yīng)用1.5T MRI評價擴張型心肌病患者的心功能是可行的。CMRI能夠直觀的顯示擴張型心肌病患者的心臟形態(tài)大小、心功能、病變的部位、范圍和程度,綜合分析CMRI各項結(jié)構(gòu)和功能參數(shù),聯(lián)合臨床心功能NAYA分級及血漿標(biāo)志物如血漿腦鈉肽等,可以準(zhǔn)確、全面地評價擴張型心肌病,為臨床治療及預(yù)后提供有效依據(jù)。
[Abstract]:Objective: to evaluate the global cardiac function of patients with dilated cardiomyopathy (DCM) by 1.5T cardiac magnetic resonance technique (CMRI) and to evaluate the value of 1.5T MRI in cardiovascular disease. Methods: 40 cases of dilated cardiomyopathy and 25 cases of normal control group were collected, 40 cases of dilated cardiomyopathy and 25 cases of normal control group were examined by magnetic resonance imaging, or left ventricular end-systolic volume was obtained. End diastolic volume and ejection fraction, end-systolic diameter and end-diastolic diameter, left ventricular end-systolic and end-diastolic spherical index. The plasma brain natriuretic peptide (BNP) and cardiac function grading (NYHA) were measured in patients with dilated heart disease and normal control group. To compare the structural and functional parameters of left ventricle between the two groups, and to analyze the correlation between the structure and function parameters of left ventricle in patients with dilated heart disease. The diagnostic value of left ventricular structure and function parameters in patients with dilated heart disease was drawn by drawing ROC curve to evaluate the diagnostic value of .3in patients with dilated heart disease. To analyze the correlation between left ventricular function parameters and New York cardiac function grading in patients with dilated heart disease. To analyze the correlation between left ventricular function parameters and plasma brain natriuretic peptide (BNP) in patients with dilated heart disease. To analyze the correlation between plasma brain natriuretic peptide (BNP) and New York cardiac function grade. The main MRI findings of patients with dilated heart disease were analyzed. The result is 1: 1. The parameters of left ventricular structure and function in patients with dilated heart disease have good correlation. All the parameters of structure and function have high diagnostic value. 2. The results of Spearman correlation analysis showed that there was a negative correlation between left ventricular ejection fraction (LVEF) and cardiac function grading in New York heart disease patients. 3. Spearman correlation analysis showed that there was a negative correlation between left ventricular ejection fraction (LVEF) and New York cardiac function grading. 3. Spearman correlation analysis showed that DHD patients had a negative correlation with LVEF. There was a negative correlation between left ventricular ejection fraction (LVEF) and LG BNP. 4. Spearman correlation analysis showed that there was a positive correlation between LG BNP and New York cardiac function grading. In 31 patients with dilated heart disease (77.5%), delayed enhancement was found in the left ventricular subendocardial and / or middle myocardial plaques, with a total of 231 segments, in which the basal segment and the middle segment of the left ventricular subendocardium were the most common. Conclusion: cardiac magnetic resonance imaging is the gold standard for measuring the parameters of left ventricular structure and function. It is feasible to evaluate the cardiac function of patients with dilated cardiomyopathy by 1.5T MRI. CMRI can directly display the size of the heart, the heart function, the location, the extent and the degree of the lesion. The structure and function parameters of CMRI are analyzed synthetically. The combination of clinical cardiac function NAYA classification and plasma markers such as plasma brain natriuretic peptide can accurately and comprehensively evaluate dilated cardiomyopathy and provide effective basis for clinical treatment and prognosis.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.2;R445.2

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