CAJ | 학술논문

目的：用磁共振评估急性心肌梗死（ AMI ）患者心肌活性，并分析其与超敏 C反应蛋白（ hs-CRP）的相关性。方法选择AMI患者43例，健康对照组30名，利用磁共振灌注及延迟成像将AMI患者分为透壁增强组、非透壁增强组和混合组。AMI患者于经皮冠状动脉介入治疗（PCI）术前及术后6个月分别行心脏磁共振分析梗死心肌质量、左室射血分数及室壁运动异常评分的变化。 AMI患者分别于病程第7日及PCI术后6个月抽取肘静脉血测血清hs-CRP水平。健康对照组抽1次血测血清hs-CRP水平。分析PCI术前及术后血清hs-CRP水平的变化及与磁共振检测结果的相关性。结果梗死心肌质量及室壁运动异常评分在PCI术后均减少，梗死心肌质量在非透壁增强组及混合组中减少差异有统计学意义（P＜0．05），室壁运动异常评分在非透壁增强组降低（P＜0．05）；左室射血分数在3组患者PCI术后均增加，在非透壁增强组及混合组中增加差异有统计学意义（P＜0．05）。 PCI术前及术后6个月血清hs-CRP较健康对照组均降低，但术前与健康对照组比较差异有统计学意义（P＜0．05）。 PCI术后6个月血清中hs-CRP较术前明显降低（P＜0．05）。 PCI术前的左室射血分数与血清中hs-CRP独立相关（R2=0．318，P＜0．05）。结论磁共振灌注技术可以有效预测心肌梗死患者的心肌活性，对临床治疗及评估预后具有较为重要的临床价值。检测血清hs-CRP对预测心肌活性，评估冠状动脉缺血严重程度及判断预后具有一定的临床意义。
목적：용자공진평고급성심기경사（ AMI ）환자심기활성，병분석기여초민 C반응단백（ hs-CRP）적상관성。방법선택AMI환자43례，건강대조조30명，이용자공진관주급연지성상장AMI환자분위투벽증강조、비투벽증강조화혼합조。AMI환자우경피관상동맥개입치료（PCI）술전급술후6개월분별행심장자공진분석경사심기질량、좌실사혈분수급실벽운동이상평분적변화。 AMI환자분별우병정제7일급PCI술후6개월추취주정맥혈측혈청hs-CRP수평。건강대조조추1차혈측혈청hs-CRP수평。분석PCI술전급술후혈청hs-CRP수평적변화급여자공진검측결과적상관성。결과경사심기질량급실벽운동이상평분재PCI술후균감소，경사심기질량재비투벽증강조급혼합조중감소차이유통계학의의（P＜0．05），실벽운동이상평분재비투벽증강조강저（P＜0．05）；좌실사혈분수재3조환자PCI술후균증가，재비투벽증강조급혼합조중증가차이유통계학의의（P＜0．05）。 PCI술전급술후6개월혈청hs-CRP교건강대조조균강저，단술전여건강대조조비교차이유통계학의의（P＜0．05）。 PCI술후6개월혈청중hs-CRP교술전명현강저（P＜0．05）。 PCI술전적좌실사혈분수여혈청중hs-CRP독립상관（R2=0．318，P＜0．05）。결론자공진관주기술가이유효예측심기경사환자적심기활성，대림상치료급평고예후구유교위중요적림상개치。검측혈청hs-CRP대예측심기활성，평고관상동맥결혈엄중정도급판단예후구유일정적림상의의。
Objective To determine the correlation between myocardial activity and high-sensitivity C-reactive protein (hs-CRP) by conducting magnetic resonance perfusion imaging in patients with acute myocardial infarction (AMI). Methods We recruited 43 patients with AMI and 30 normal controls. Patients with AMI were allocated to be subjected to magnetic resonance perfusion imaging for assessment of myocardial activity and, based on the extent of myocardial infarction manifested in the delayed enhancement magnetic resonance imaging (DE-MRI), divided into transmural enhancement group, non-transmural enhancement group and mixed group. Patients with AMI were assessed for myocardial activity in terms of the infarct mass, abnormal wall motion score and left ventricular ejection fraction (LVEF) by using the DE-MRI before percutaneous coronary intervention (PCI) and at month 6. The level of serum hs-CRP in patients with AMI was measured at day 7 after symptom onset and at month 6 after PCI. Blood sample were collected once in the healthy controls for assessment of serum hs-CRP. The correlation between serum hs-CRP and myocardial activity in AMI patients was analyzed by magnetic resonance perfusion imaging before PCI and at month 6. Results The infarct mass after PCI was significantly decreased in the non-transmural enhancement group and mixed group (both P<0.05). The ventricular abnormality score was markedly reduced in the non-transmural enhancement group. The LVEF was significantly improved after PCI in all groups (P<0.05), particularly in non-transmural enhance-ment group and mixed group. The levels of hs-CRP before PCI and at month 6 (esp. the former) were significantly higher compared with healthy controls (both P<0.05). There was a reduction in the level of hs-CRP following PCI (P<0.05). LVEF before PCI was independently correlated with the level of hs-CRP (R2=0.318, P<0.05). Conclusion Magnetic resonance perfusion imaging may effectively assess myocardial activity, suggesting the clinical utility for therapeutic assessment and prognosis prediction. Detection of serum of hs-CRP can predict the activity of myocardium, disease severity and prognosis in patients with myocardial infarction.