CAJ | 학술논문

目的探讨心肌内心电图(IMEG)在诊断心脏移植术后急性排斥反应中的作用,并评估其可靠性.方法 2004年6月至2009年3月,对32例心脏移植受者植入永久性心脏起搏器,分析自主IMEG的QRS波幅(以下简称为"QRS")和心室起搏心电图(VER)的T波后支最大斜率(Tslew)变化在诊断急性排斥反应中的作用;同期进行心内膜心肌活检(EMB),对QRS和Tslew与EMB诊断急性排斥反应进行了对照.结果共采集IMEG 523例次,同时有自主IMEG、心室起搏VER和EMB数据的41例次,其中病理检查诊断急性排斥反应阳性17例次,阴性24例次;QRS的ROC曲线下面积(AUC)0.7537,敏感度(Se)为88.24%,特异度(Sp)为62.50%,诊断符合率为73.17%;Tslew的AUC为0.9081,Se为94.12%,Sp为87.50%,诊断符合率为90.24%;QRS与Tslew的AUC比较,Tslew优于QRS,差异有统计学意义(x2=4.22,P＜0.05);联合诊断(QRS和Tslew之一阳性诊断为阳性,同时阴性诊断为阴性)AUC为0.7917,Se为100.00%,Sp为58.33%,诊断符合率为75.61%.结论自主IMEG的QRS、心室起搏VER的Tslew用于诊断心脏移植术后急性排斥反应均是可靠指标,但Tslew优于QRS;联合应用两项指标诊断心脏移植术后急性排斥反应也是可靠指标.
목적 탐토심기내심전도(IMEG)재진단심장이식술후급성배척반응중적작용,병평고기가고성.방법 2004년6월지2009년3월,대32례심장이식수자식입영구성심장기박기,분석자주IMEG적QRS파폭(이하간칭위"QRS")화심실기박심전도(VER)적T파후지최대사솔(Tslew)변화재진단급성배척반응중적작용;동기진행심내막심기활검(EMB),대QRS화Tslew여EMB진단급성배척반응진행료대조.결과 공채집IMEG 523례차,동시유자주IMEG、심실기박VER화EMB수거적41례차,기중병리검사진단급성배척반응양성17례차,음성24례차;QRS적ROC곡선하면적(AUC)0.7537,민감도(Se)위88.24%,특이도(Sp)위62.50%,진단부합솔위73.17%;Tslew적AUC위0.9081,Se위94.12%,Sp위87.50%,진단부합솔위90.24%;QRS여Tslew적AUC비교,Tslew우우QRS,차이유통계학의의(x2=4.22,P＜0.05);연합진단(QRS화Tslew지일양성진단위양성,동시음성진단위음성)AUC위0.7917,Se위100.00%,Sp위58.33%,진단부합솔위75.61%.결론 자주IMEG적QRS、심실기박VER적Tslew용우진단심장이식술후급성배척반응균시가고지표,단Tslew우우QRS;연합응용량항지표진단심장이식술후급성배척반응야시가고지표.
Objective To investigate the reliability of intramyocardial electrogram (IMEG) in monitoring acute rejection after human heart transplantation. Methods From June 2004 to March 2009, 32 patients underwent orthotopic heart transplantations. During the operation telemetric pacemakers were placed under the skin of the body with connected bipolar electrodes implanted into epimyocardium. Postoperative IMEGs, including the autonomous IMEG and ventricular evoked response (VER) were recorded routinely. The endomyocardium biopsy (EMB) was taken routinely and performed once again when positive IMEG results or other positive signs were observed. Results Totally 523 IMEGs has been produced, 41 of VERs were recorded together with autonomous IMEGs and EMBs, in which 17 EMB specimens were confirmed positive and 24 negative. AUC of QRS was 0.7537, Se was 88.24%, Sp was 62. 50%; AUC of Tslew was 0. 9081, Se was 94. 12%, Sp was 87. 50%. QRS and Tslew had significant difference in AUC of ROC, with x2 = 4. 22, P＜0. 05; AUC of combined diagnostic index (positive when either QRS or Tslew is positive and negative when both values are negative) was 0. 7917, Se was 100.00%, Sp was 58. 33%. Conclusion QRS amplitude of the autonomous IMEGs, Tslew of VERs and combined diagnostic index are reliable indexes for monitoring acute allograft rejection after human heart transplantation. Furthermore, Tslew has a better prognostic value than QRS.