CAJ | 학술논문

目的评估心肌内心电图(IMEG)心室起搏(VER)的T波后支斜率(Tslew)用于诊断大鼠异体心脏移植术后急性排斥反应的可靠性.方法建立改良Ono大鼠腹部异位心脏移植动物模型,对照组(同基因移植)10只,实验组(异基因移植)30只.在供心右室流出道、左室游离壁和左室心尖部的心肌处分别埋置心表起搏电极,用两根导线作为起搏电极,描记VER,测Tslew.对照组术后第7天、实验组分别在术后3、5、7天处死,移植心脏作病理活检.结果术后3、5、7天各时点,对照组Tslew差异无统计学意义,实验组呈进行性下降,术后3～5天、3～7天之间两两差异有统计学意义(P＜0.05);两组间比较第5、7天差异有统计学意义(P＜0.05),实验组Tslew变化与病理相关(P＜0.05);Tslew的ROC曲线下面积为0.9474,95%可信区间(0.8753～1. 0000);在最佳分割点(≤90%)灵敏度94.74%,特异度81.82%,阳性预测值和阴性预测值、符合率90%.Tslew≤92%为阳性分割点,灵敏度100%,特异度63.64%;≤85%作为阳性分割点,特异度90.91%,灵敏度78.95%.结论 Tslew是诊断大鼠心脏移植术后急性排斥反应的可靠指标;在最佳分割点,Tslew具有良好的诊断价值,缺乏心内膜活检条件时可以作为替代或补充;在适当分割点,Tslew可以作为急性排斥反应筛选的敏感指标.
목적 평고심기내심전도(IMEG)심실기박(VER)적T파후지사솔(Tslew)용우진단대서이체심장이식술후급성배척반응적가고성.방법 건립개량Ono대서복부이위심장이식동물모형,대조조(동기인이식)10지,실험조(이기인이식)30지.재공심우실류출도、좌실유리벽화좌실심첨부적심기처분별매치심표기박전겁,용량근도선작위기박전겁,묘기VER,측Tslew.대조조술후제7천、실험조분별재술후3、5、7천처사,이식심장작병리활검.결과 술후3、5、7천각시점,대조조Tslew차이무통계학의의,실험조정진행성하강,술후3～5천、3～7천지간량량차이유통계학의의(P＜0.05);량조간비교제5、7천차이유통계학의의(P＜0.05),실험조Tslew변화여병리상관(P＜0.05);Tslew적ROC곡선하면적위0.9474,95%가신구간(0.8753～1. 0000);재최가분할점(≤90%)령민도94.74%,특이도81.82%,양성예측치화음성예측치、부합솔90%.Tslew≤92%위양성분할점,령민도100%,특이도63.64%;≤85%작위양성분할점,특이도90.91%,령민도78.95%.결론 Tslew시진단대서심장이식술후급성배척반응적가고지표;재최가분할점,Tslew구유량호적진단개치,결핍심내막활검조건시가이작위체대혹보충;재괄당분할점,Tslew가이작위급성배척반응사선적민감지표.
Objective This study aimed to evaluate the reliability of Tslew in survelliance of allograft rejection after heart transplantations in rats. Methods Forty rats underwent modified Ono's heterotopic heart transplantation. The autonomous IMEG and VER were recorded with epicardiac pacing leads fixed at right ventricular outflow tracts, left ventricular apex and free wall. Tslews were detected daily in these 10 syngeneic and 30 allogeneic transplants. Syngeneic transplants were sacrificed on 7th postoperative day and allogeneic transplants were sacrificed on 3rd, 5th and 7th postoperative days, respectively.Histopathologic studies were performed at the same time. Results On the 3rd ,5th and 7th postoperative days Tslews depressed gradually in the allogeneic group. The depressions between 3rd and 5th, 3rd and 7th were obvious( P ＜0.05 ). No significant differences were observed in the syngeneic group. Tslews differed between the two groups at 5th and 7th postoperative days ( P ＜0.05 ). The Depression correlated with histopathologic results. Area under ROC( receiver operating characteristic) curve (AUC) of Tslew was 0.9474 and the 95% confidence interval(CI) was (0. 8753 -1. 0000 ). At the cutoff point of 92% ( ≤92% considered positive), Tslew had a sensitivity (Se) 100%, specificity (Sp) 63.64%, positive predictive value (PV + )82.61%, negative predictive value (PV-) 100%, respectively. At the cutoff point 85%, Sp 90.91%, Se 78.95%, PV +93.75 %, PV- 71. 43%. At the best cutoff point 90%, Tslew had a Se 94.74%, Sp 81. 82%, PV + 82.61%, PV- 90%.Whereas QRS had a Se 68.42%, Sp 90.91%, PV + 92.86%, PV- 62.50% at the best cutoff point of 72.3%. Conclusion Tslew of VER are reliable indexs to monitor acute allograft rejection after heart transplantations in rats. Having great diagnostic value, Tslew may be used as a replacement for EMB at the best cutoff point when EMB can' t be performed. At cutoff point of 92%, Tslew may be used as a screening index.