艾滋病患者心肌损伤的前瞻性心脏磁共振研究

doi:10.19871/j.cnki.xfcrbzz.2022.03.009

新发传染病电子杂志 ›› 2022, Vol. 7 ›› Issue (3): 41-45.doi: 10.19871/j.cnki.xfcrbzz.2022.03.009

艾滋病患者心肌损伤的前瞻性心脏磁共振研究

张娜¹, 江南¹, 高月琴¹, 蔡琳², 谢利秋¹, 谢贤维¹, 郑海燕¹, 侯可可¹

1. 成都市公共卫生临床医疗中心放射科,成都 610061;
2. 成都市公共卫生临床医疗中心感染科,成都 610061

收稿日期:2021-08-30 出版日期:2022-07-31 发布日期:2022-09-08
通讯作者: 侯可可,Email：15980980@qq.com
基金资助:
1.四川省医学科研课题计划（S19001）; 2.成都市医学科研课题(2021024); 3.四川省卫生健康委员会科研项目（21JP155）

Prospective cardiac magnetic resonance study of myocardial injury in AIDS patients

Zhang Na¹, Jiang Nan¹, Gao Yueqin¹, Cai Lin², Xie liqiu¹, Xie Xianwei¹, Zheng Haiyan¹, Hou Keke¹

1. Department of Radiology Chengdu Public Health Clinical Medical Center, Chengdu 610061, China;
2. Department of Infection Chengdu Public Health Clinical Medical Center, Chengdu 610061, China

Received:2021-08-30 Online:2022-07-31 Published:2022-09-08

摘要/Abstract

摘要： 目的采用心脏磁共振（CMR）综合评估艾滋病患者心肌组织和心功能改变。方法前瞻性纳入2020年7月至2021年6月在成都市公共卫生临床医疗中心治疗男性45例AIDS患者及匹配的18例正常对照组进行CMR增强扫描,对图像资料进行后处理分析,评估包括水肿、微循环障碍及纤维化在内的心肌组织改变;包括容积参数、射血分数、左心室重构指数（LVRI）在内的心功能指标;包括二尖瓣和三尖瓣结构和功能改变;并进一步比较艾滋病合并/未合并心脏受累与正常对照组的心功能指标。结果 16例（35.5%)的艾滋患者出现包括左右心室收缩功能减低、心肌水肿、二尖瓣及三尖瓣瓣膜增厚、三尖瓣反流、心肌微循环障碍在内的心脏受累表现。与正常对照组相比,合并及未合并心脏受累的艾滋病患者左右心室容积参数均未见明显减低（均P>0.05）;而合并心脏受累组左心室射血分数及左心室搏出量较未合并心脏受累组及正常对照组表现出减低趋势。此外,未合并心脏受累组左心室重构指数较正常对照组明显升高[（1.62±0.26）比（1.45±0.24）, P=0.025],而合并心脏受累组LVRI较正常对照组未见明显增高。结论艾滋病患者心脏并发症较常见,包括瓣膜改变、心脏收缩功能减低、心肌水肿及微循环障碍等,在早期左右心室容积参数、射血分数尚未发生明显改变时,艾滋病患者已经发生左心室重构（LVRI改变）,CMR能为早期评估艾滋病患者的亚临床心肌损伤提供客观证据。

关键词: 获得性免疫缺陷综合征, 心脏磁共振, 心肌损伤, 前瞻性研究

Abstract: Objective To evaluate the changes of myocardial tissue and cardiac function in AIDS patients by cardiac magnetic resonance imaging (CMR). Method 45 male AIDS patients and 18 healthy controls were prospectively included for CMR scanning. Post-processing analysis was performed to evaluate cardiac involvement. Myocardial tissue changes, including edema, microcirculation disorders and fibrosis; including cardiac function indexes, volume parameters, ejection fraction and left ventricular remodeling index (LVRI); Changes in mitral and tricuspid valve structure and function were assessed. Furthermore, the cardiac function indexes of AIDS patients with/without heart involvement and normal controls were compared. Result 16 cases (35.5%) of AIDS patients presented with cardiac involvement, including reduced systolic function of left and right ventricles, myocardial edema, the mitral and tricuspid valves thickened, triapphal regurgitation and myocardial microcirculation disturbance. There was no significant reduction in left and right ventricular volume parameters in AIDS patients with/without cardiac involvement compared with normal controls (all P>0.05). The left ventricular ejection fraction and left ventricular stroke volume of AIDS patients with heart involvement showed a decreasing trend compared with AIDS patients without heart involvement and normal control. The left ventricular remodeling index of AIDS patients without heart involvement was significantly higher than that of the normal control (1.62±0.26 vs 1.45±0.24, P=0.025), and the LVRI of AIDS patients with heart involvement was not significantly higher than that of the normal control. Conclusion Cardiac involvement in patients with HIV/AIDS is common, such as changes in valves, cardiac dysfunction, myocardial edema and microcirculation, etc. HIV/AIDS patients have developed left ventricular remodeling when the left ventricular volume and ejection fraction has not significantly change in the early stage. CMR could provide more comprehensive objective evidence for assessing myocardial injury of AIDS patients in the early stage.

Key words: Acquired immune deficiency syndrome, Cardiac magnetic resonance, Myocardial injury, Prospective study

张娜, 江南, 高月琴, 蔡琳, 谢利秋, 谢贤维, 郑海燕, 侯可可. 艾滋病患者心肌损伤的前瞻性心脏磁共振研究[J]. 新发传染病电子杂志, 2022, 7(3): 41-45.

Zhang Na, Jiang Nan, Gao Yueqin, Cai Lin, Xie liqiu, Xie Xianwei, Zheng Haiyan, Hou Keke. Prospective cardiac magnetic resonance study of myocardial injury in AIDS patients[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(3): 41-45.

参考文献

[1] 中华医学会感染病学分会艾滋病丙型肝炎学组,中国疾病预防控制中心.中国艾滋病诊疗指南(2021年版)[J].中华内科杂志,2021,60(12):1106-1128.
[2] 中国疾病预防控制中心.艾滋病疫情数据摘要[EB/OL].[2018-03-15].https://ncaids.chinacdc.cn/xxgx/yqbh/.
[3] MOSKOWITZ L, HENSLEY GT, CHAN JC, et al.Immediate causes of death in acquired immunodeficiency syndrome[J]. Arch Pathol Lab Med, 1985, 109(8):735-738.
[4] DE CASTRO S, MIGLIAU G, SILVESTRI A, et al.Heart involvement in AIDS: a prospective study during various stages of the disease[J]. Eur Heart J, 1992,13(11):1452-1459.
[5] LUETKENS JA, DOERNER J, SCHWARZE-ZANDER C, et al.Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients[J]. Circ Cardiovasc Imaging, 2016,9(3):e004091.
[6] DE LEUW P, ARENDT CT, HABERL AE, et al.Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV[J]. JACC Cardiovasc Imaging,2021,14(8):1548-1557.
[7] D'AMATI G, DI GIOIA CR, GALLO P. Pathological findings of HIV-associated cardiovascular disease[J]. Ann N Y Acad Sci, 2001, 946:23-45.
[8] LEWIS W.AIDS: cardiac findings from 115 autopsies[J]. Prog Cardiovasc Dis,1989,32(3):207-215.
[9] BUTLER J, GREENE SJ, SHAH SH, et al.Diastolic dysfunction in patients with human immunodeficiency virus receiving antiretroviral therapy: results from the CHART Study[J]. J Card Fail, 2020, 26(5):371-380.
[10] REINSCH N, KAHLERT P, ESSER S, et al.Echocardiographic findings and abnormalities in HIV-infected patients: results from a large, prospective,multicenter HIV-heart study[J]. Am J Cardiovasc Dis, 2011, 1(2):176-184.
[11] LEWIS W.Cardiomyopathy in AIDS: a pathophysiological perspective[J]. Prog Cardiovasc Dis, 2000, 43(2):151-70.
[12] BARBARO G, FISHER SD, LIPSHULTZ SE.Pathogenesis of HIV-associated cardiovascular complications[J]. Lancet Infect Dis, 2001, 1(2):115-124.
[13] CHAVES AA, MIHM MJ, SCHANBACHER BL, et al.Cardiomyopathy in a murine model of AIDS: evidence of reactive nitrogen species and corroboration in human HIV/AIDS cardiac tissues[J]. Cardiovasc Res, 2003, 60(1):108-118.
[14] MAGULA NP, MAYOSI BM.Cardiac involvement in HIV-infected people living in Africa: a review[J]. Cardiovasc J S Afr, 2003, 14(5):231-237.
[15] NTUSI NAB, NTSEKHE M.Human immunodeficiency virus-associated heart failure in sub-Saharan Africa: Evolution in the epidemiology, pathophysiology, and clinical manifestations in the antiretroviral era[J]. ESC Hear Fail, 2016, 3(3):158-167.
[16] 韩晓涛,董茜,宋毓青,等.HIV感染者右心系统病变的超声心动图特征及其与CD4+T淋巴细胞计数的相关性[J].中国艾滋病性病, 2019, 25(10):1015-1018, 1029.
[17] SANI MU.Myocardial disease in human immunodeficiency virus (HIV) infection: a review[J]. Wien Klin Wochenschr, 2008, 120(3-4):77-87.
[18] DE LEUW P, ARENDT CT, HABERL AE, et al.Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV[J]. JACC Cardiovasc Imaging, 2021, 14(8):1548-1557.
[19] KHOURI MG, PESHOCK RM, AYERS CR, et al.A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study[J]. Circ Cardiovasc Imaging, 2010, 3(2):164-171.
[20] OMAR M, JENSEN J, ALI M, et al.Associations of Empagliflozin With Left Ventricular Volumes, Mass, and Function in Patients With Heart Failure and Reduced Ejection Fraction: A Substudy of the Empire HF Randomized Clinical Trial[J]. JAMA Cardiol, 2021, 6(7):836-840.

艾滋病患者心肌损伤的前瞻性心脏磁共振研究

Prospective cardiac magnetic resonance study of myocardial injury in AIDS patients

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