摘要
目的:结缔组织病(connective tissue diseases,CTD)患者心脏受累发生率高,起病隐匿且可迅速进展,是CTD患者的主要死亡原因之一。多参数心脏磁共振(cardiovascular magnetic resonance,CMR)能多角度定量评估心脏损伤,是检测CTD患者心脏受累的新工具。本研究旨在探究CTD心脏受累的CMR特征与血清学生物标志物的相关性及潜在的临床价值,同时探究接受CMR检查前的免疫治疗强度对CMR特异度指标的影响,评估CMR在早期诊断CTD心脏受累中的临床应用前景。方法:对2019年9月至2024年3月在中南大学湘雅医院就诊并接受CMR检查的连续性CTD患者(72例)进行回顾性分析,收集患者的临床一般资料、血清学指标和CMR参数。对临床血清学指标阳性与阴性CTD患者组的CMR参数进行差异性分析,对不同血清学指标与CMR参数之间的相关性进行分析,同时,对于不同病种的CTD患者进行亚组分析。此外,通过单因素和多因素Logistic回归分析探讨接受CMR检查前的免疫治疗强度对CMR特征性参数的影响,并利用受试者操作特征(receiver operating characteristic,ROC)曲线确定截断值。结果:在差异性分析中,白细胞介素(interleukin,IL)-1β、IL-6水平升高CTD患者的CMR参数心肌T2值显著高于IL-1β、IL-6水平正常的患者(分别P=0.014,P=0.012)。在IL-10水平升高的CTD患者中,观察到更高比例的CMR微血管病变(P=0.038)。相关性分析发现,高敏肌钙蛋白T(high-sensitive cardiac troponin T,hs-cTnT)与T2值之间存在显著正相关(r=0.371,P=0.009)。ROC曲线分析表明,当hs-cTnT阈值为0.01 ng/mL时,预测左室心肌T2值升高的敏感度和特异度分别为85.71%和61.11%[ROC曲线下的面积(area under the curve,AUC)=0.767,P=0.001]。此外,hs-cTnT、肌酸激酶(creatine kinase,CK)与增强前T1值之间亦存在正相关(r=0.371,P=0.009;r=0.364,P=0.032)。红细胞沉降率(erythrocyte sedimentation rate,ESR)与钆延时强化(late gadolinium enhancement,LGE)的百分比之间存在正相关(r=0.236,P=0.047)。而hs-cTnT与全局径向应变(global radial strain,GRS)呈负相关(r=−0.297,P=0.034),同时CK与GRS、全局周向应变(global radial strain,GCS)均呈负相关(r=−0.292,P=0.022;r=−0.282,P=0.027)。在hscTnT升高的患者中,接受CMR检查前的糖皮质激素累积剂量与T2值升高呈负相关(OR=0.997,P=0.018),即使在调整激素使用时间后,该相关性依然显著(OR=0.997,P=0.044)。ROC曲线分析显示,当糖皮质激素累积剂量不超过613 mg/mL(等效泼尼松剂量)时,预测T2值升高的敏感度和特异度分别为90.48%和77.78%(AUC=0.862,P<0.001)。结论:在多种临床血清学生物标志物中,多个炎症指标与部分特定CMR参数存在相关性,hs-cTnT与CMR多参数具有较高的相关性,其升高提示CTD患者可能存在心脏受累。此外,接受CMR检查前的免疫治疗强度对T2 mapping的特异度具有显著影响,这表明免疫治疗强度对CMR特异度指标有显著影响。这些发现为临床医师在早期识别CTD患者的心脏受累、及时进行干预治疗以及疾病评估提供了重要的信息和参考依据。未来研究需进一步探讨CMR在CTD心脏受累评估中的作用,以及如何结合CMR与其他临床资料优化CTD患者的诊疗方案。
Objective:Patients with connective tissue diseases(CTD)have a high incidence of cardiac involvement,which often presents insidiously and can progress rapidly,making it one of the leading causes of death.Multiparametric cardiovascular magnetic resonance(CMR)provides a comprehensive quantitative evaluation of myocardial injury and is emerging as a valuable tool for detecting cardiac involvement in CTD.This study aims to investigate the correlations between CMR features and serological biomarkers in CTD patients,assess their potential clinical value,and further explore the impact of pre-CMR immunotherapy intensity on CMR-specific parameters,thereby evaluating the role of CMR in the early diagnosis of CTD-related cardiac involvement.Methods:A retrospective analysis was conducted on 72 consecutive CTD patients who underwent CMR at Xiangya Hospital of Central South University between September 2019 and March 2024.Clinical data,serological markers,and CMR parameters were collected.Differences in CMR parameters were compared between CTD patients with positive and negative serological markers.Correlations between serological biomarkers and CMR parameters were analyzed,with subgroup analyses performed for different CTD subtypes.Logistic regression(univariate and multivariate)was applied to explore the effects of pre-CMR immunotherapy intensity on CMR parameters,and receiver operating characteristic(ROC)curve analysis was used to determine cutoff values.Results:In differential analyses,CTD patients with elevated interleukin(IL)-1βand IL-6 levels exhibited significantly higher myocardial T2 values compared with those with normal levels(P=0.014,P=0.012).Elevated IL-10 was associated with a higher prevalence of microvascular lesions on CMR(P=0.038).Correlation analysis revealed a significant positive association between high-sensitivity cardiac troponin T(hs-cTnT)and T2 values(r=0.371,P=0.009).ROC analysis indicated that when the hs-cTnT threshold was 0.01 ng/mL,the sensitivity and specificity for predicting elevated left ventricular T2 values were 85.71%and 61.11%,respectively[area under the curve(AUC)=0.767,P=0.001].hs-cTnT and creatine kinase(CK)were also positively correlated with native T1 values(r=0.371,P=0.009;r=0.364,P=0.032).Erythrocyte sedimentation rate(ESR)showed a positive correlation with the percentage of the late gadolinium enhancement(LGE)(r=0.236,P=0.047).Conversely,hs-cTnT correlated negatively with global radial strain(GRS)(r=−0.297,P=0.034),while CK correlated negatively with both GRS and global circumferential strain(GCS)(r=−0.292,P=0.022;r=−0.282,P=0.027).Among patients with elevated hs-cTnT,the cumulative glucocorticoid dose prior to CMR was negatively associated with elevated T2 values(OR=0.997,P=0.018),and this correlation remained significant after adjusting for duration of steroid use(OR=0.997,P=0.044).ROC analysis showed that when the cumulative glucocorticoid dose did not exceed 613 mg/mL(prednisone equivalent),the sensitivity and specificity for predicting elevated T2 values were 90.48%and 77.78%,respectively(AUC=0.862,P<0.001).Conclusion:Several inflammatory biomarkers demonstrate correlations with specific CMR parameters,with hs-cTnT showing the strongest associations across multiple indices.Elevated hs-cTnT suggests a high likelihood of cardiac involvement in CTD patients.Furthermore,pre-CMR immunotherapy intensity significantly influences the specificity of T2 mapping,indicating its importance in interpreting CMR results.These findings provide critical insights for clinicians in the early recognition,timely intervention,and disease evaluation.Future research should further explore the role of CMR in the assessment of CTD-related cardiac assessment of CTD-related cardiac involvement.Future studies should further explore the role of CMR in evaluating CTD cardiac manifestations and its integration with other clinical data to optimize patient management.
作者
罗静
周晖
李懿莎
侯阳振
杨吉
刘洋腾宇
LUO Jing;ZHOU Hui;LI Yisha;HOU Yangzhen;YANG Ji;LIU Yangtengyu(Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008;Hunan Engineering Research Center for Intelligent Medical Imaging,Furong Laboratory,Changsha 410008;Department of Rheumatology and Immunology,Xiangya Hospital,Central South University,Changsha 410008;Hunan Provincial Clinical Research Center for Rheumatic and Immunologic Diseases,Changsha 410008,China)
出处
《中南大学学报(医学版)》
北大核心
2025年第5期777-792,共16页
Journal of Central South University (Medical Science)
基金
国家重点研发计划(2022YFC2010000,2022YFC2010006)
国家自然科学基金(82302052)。
关键词
结缔组织病
心脏磁共振
心肌
高敏肌钙蛋白T
治疗
connective tissue disease
cardiovascular magnetic resonance
myocardium
high-sensitivity cardiac troponin T
therapy
