基于T1 mapping测量慢性肾病患者心肌纤维化的准确性及预后价值研究

Cardiovascular disease is the most common complication in patients with chronic kidney disease and main cause of death in patients with end-stage renal disease. It is reported that myocardial fibrosis is the important physiological and pathological basis of the change of cardiac structure and function in patients with chronic kidney disease. It has important value to longitudinally observe the relationship between the change of myocardial fibrosis and the incidence rate of cardiovascular events to explore the cause of myocardial fibrosis and to assess the prognosis of the patients with chronic kidney disease. T1 mapping technology, as a novel magnetic resonance imaging technique, can accurately and noninvasively detect myocardial fibrosis with high accuracy. This project will detect the accuracy of T1 mapping technique in the diagnosis of myocardial fibrosis in patients with chronic kidney disease with the myocardial biopsy as the reference standard. Then T1 mapping technology will be used to assess the relationship between the changes of myocardial fibrosis and incidence rate of cardiovascular events with the change of renal function and to explore the effects of myocardial fibrosis on the occurrence and development of cardiovascular disease in patients with chronic kidney disease. T1 mapping technology can accurately diagnose myocardial fibrosis of chronic renal disease patients, and become a biological imaging targets to follow-up and evaluate curative effect for patients with chronic kidney disease and cardiovascular disease.

心血管疾病是慢性肾病患者常见的并发症，是终末期肾病患的首位死亡原因。研究显示，心肌纤维化是慢性肾病患者心脏结构和功能发生变化的重要的病理生理基础。纵向观察心肌纤维化的变化及其与患者心血管事件发生的关系对探索心肌纤维化发生的原因及评估患者预后有重要的价值。T1 mapping技术是一种新型的磁共振技术，它可以无创检测心肌纤维化并且有较高的准确性。本课题首先以心肌活检为参考标准确定T1 mapping技术诊断慢性肾病患者心肌纤维化准确性，再利用T1 mapping技术评估随着肾功能的进展及肾移植前后患者心肌纤维化的变化及其与心血管事件发生的关系，探索心肌纤维化在慢性肾病患者心血管疾病发生和发展的作用。预期心肌T1 mapping技术可以准确诊断慢性肾病患者心肌纤维化并能用于慢性肾病患者心血管疾病随访和疗效评估的生物影像指标。

心血管疾病是慢性肾病（Chronic kidney disease，CKD）患者常见的并发症，是终末期肾病（end-stage renal disease，ESRD）患者的首位死亡原因。心肌纤维化是慢性肾病患者心脏结构和功能发生变化的重要的病理生理基础。本研究利用T1 mapping技术评估随着CKD的进展及肾移植前后患者心肌纤维化的变化，探索心肌纤维化在CKD患者中的发生发展的可能原因及可逆性，为临床治疗心肌纤维化提供一个方向或依据。. 通过比较22名正常志愿者、66名早中期CKD患者及52名晚期CKD患者心脏电影及T1 mapping检测结果，发现心肌纤维化、心肌肥厚在CKD早中期就已经开始发生，但是心功能尚可维持，当疾病发展到终末期时，心肌肥厚及心肌纤维化进一步进展，心脏功能失代偿而下降。心脏顺应性代偿性增加也许是早中期CKD心功能维持的一个原因。在探讨心肌纤维化方面，平扫T1较ECV更加敏感，且不需要对比剂注入，适合早中期CKD患者检查。适当纠正贫血及控制高血压可减少或控制心肌纤维化发生及发展。. 为了进一步探讨肾移植对ESRD患者心肌纤维化的影响，比较了25名肾移植前及肾移植后心脏磁共振结果，发现肾移植后ESRD患者心肌纤维化、心肌肥厚、心室扩张及收缩障碍均可得到好转。

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