CAJ | 학술논문

目的探讨应用心肌内心电图QRS波幅诊断大鼠心脏移植术后急性排斥反应的最佳临界值.方法建立改良Ono法大鼠腹部异位心脏移植模型,在心脏移植术中分别于供心右室流出道、左室游离壁的心肌处埋置心表起搏导线,描记心肌内心电图,测量QRS波波幅.对照组大鼠(10只)术后第7天处死,实验组大鼠(30只)分别在术后3、5、7d处死,取移植心脏进行病理检查.结果病理结果阴性和阳性的QRS波幅分别为(94.4±4.6)％、(76.2±10.5)％,两者差异有统计学意义(P ＜0.05);QRS波幅的受试者工作特征(ROC)曲线下面积为0.958,在最佳分割点90％的灵敏度为90.5％,特异度为88.9％,阳性预测值为95％,阴性预测值为80％,符合率为90％.结论 QRS波幅是诊断大鼠心脏移植术后急性排斥反应可靠性较高的指标,在缺乏心肌活检条件时,可以作为诊断急性排斥反应的指标.
목적 탐토응용심기내심전도QRS파폭진단대서심장이식술후급성배척반응적최가림계치.방법 건립개량Ono법대서복부이위심장이식모형,재심장이식술중분별우공심우실류출도、좌실유리벽적심기처매치심표기박도선,묘기심기내심전도,측량QRS파파폭.대조조대서(10지)술후제7천처사,실험조대서(30지)분별재술후3、5、7d처사,취이식심장진행병리검사.결과 병리결과음성화양성적QRS파폭분별위(94.4±4.6)％、(76.2±10.5)％,량자차이유통계학의의(P ＜0.05);QRS파폭적수시자공작특정(ROC)곡선하면적위0.958,재최가분할점90％적령민도위90.5％,특이도위88.9％,양성예측치위95％,음성예측치위80％,부합솔위90％.결론 QRS파폭시진단대서심장이식술후급성배척반응가고성교고적지표,재결핍심기활검조건시,가이작위진단급성배척반응적지표.
Objective To determine the threshold value of QRS amplitude in surveillance of allograft rejection after heart transplantation in rats.Methods Forty rats underwent heterotopic heart transplantations.Intramyocardial electrogram (IMEG) was recorded with epicardiac pacing leads fixed at the right ventricular outflow tract and left ventricular free wall.QRS amplitude values were detcted daily in these 10 syngeneic and 30 allogeneic transplants.Syngeneic transplants were sacrificed on 7th postoperative day and allogeneic tansplants were sacrificed on 3rd,5th and 7th postoperative day.Respectively,histopathologic studies were performed at the same time.Results QRS amplitude differed singificantly between different histopathologic outcomes (P ＜ 0.05),(94.4 ± 4.6) ％ in negative and (76.2 ± 10.5) ％in positive.Area under receiver operating characteristic (ROC) curve of QRS amplitude was 0.958.At the best cutoff point of 90％ (≤90％ considered positive),QRS amplitude had a sensitivity 90.5％,specificity 88.9％,positive predictive value 95％,and negative predictive value 80％,respectively.Conclusion QRS amplitude is a reliable parameter to detect allograft rejection after heart transplantation in rats.Having rather good diagnostic value,QRS amplitude may be used as a replacement for EMB at the best cutoff point when EMB can't be performed.