任道元,陈铟铟,金航,徐仁德,戴宇翔,黄嘉,王齐兵,钱菊英

• 1:复旦大学附属中山医院心内科
• 2:复旦大学附属中山医院放射科

摘要(Abstract)：

目的 探讨心肌内出血（IMH）对ST段抬高型心肌梗死患者再灌注后围术期心肌肌钙蛋白T(cTnT)水平的影响以及cTnT对IMH的预测价值。方法 连续性纳入复旦大学附属中山医院2018年1月至2019年8月共计70例急性心肌梗死患者。在经皮冠状动脉介入治疗（PCI）术后4～7d接受心脏磁共振成像（CMR）检查，根据CMR表现分为IMH组（45例）和非IMH组（19例）。采用受试者工作特征（ROC）曲线评估不同时间点cTnT水平对IMH的预测价值。结果 基于不同时间点的cTnT相关性分析显示，术后即刻cTnT水平、峰值cTnT水平与CMR各参数的Spearman秩相关性最强。其中术后即刻cTnT及峰值cTnT与IMH容积呈正相关，秩相关系数分别为0.76和0.74（均P<0.001）；与IMH T2*值呈负相关，秩相关系数分别为–0.68和–0.65（均P<0.001）；与梗死容积呈正相关，秩相关系数分别为0.55和0.50（均P<0.001）；与LVEF呈负相关，秩相关系数分别为–0.66和–0.59（均P<0.001）。ROC曲线分析显示：术后即刻cTnT预测心肌梗死患者PCI术后发生IMH具有最大的AUC为0.95(P<0.001)，敏感度、特异度及准确度分别为75.6%、100.0%和82.8%，截断值为4.71 ng/ml。术后即刻cTnT预测IMH的AUC与峰值cTnT的AUC差异无统计学意义（P=0.191），而与术后1d(P=0.025)、术后3d(P=0.034)及术后5～7d(P=0.018)的差异均有统计学意义。进一步进行多变量回归分析显示，术后即刻cTnT(OR 2.40,95%CI 1.44～4.00,P=0.001)仍是STEMI患者发生IMH的独立危险因素。结论 术后cTnT水平可作为患者发生IMH的有效预测因子。

关键词(KeyWords)： 急性心肌梗死;缺血-再灌注损伤;心肌内出血;心肌肌钙蛋白T

Abstract:

Keywords:

基金项目(Foundation): 上海市卫生健康委员会科研课题（202040349）;; 上海市浦江人才计划（21PJD012）

作者(Author): 任道元,陈铟铟,金航,徐仁德,戴宇翔,黄嘉,王齐兵,钱菊英

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