【摘要】 目的 筛选心磁图用于诊断冠状动脉微循环障碍的高敏感性参数。方法 选取2022年9月至2024年3月因心绞痛于中国人民解放军总医院第一医学中心诊治的患者290例，行冠状动脉造影及基于默里定律的定量血流分数（μQFR）、冠状动脉造影衍生的微循环阻力指数（AMR）分析，将冠状动脉血管面积狭窄≥75%且≤90%、μQFR值≤0.8的患者纳入阻塞性冠状动脉粥样硬化性心脏病（冠心病）组，冠状动脉血管面积狭窄<75%、μQFR>0.8且AMR>2.5 mmHg·s/cm 的患者纳入冠状动脉微循环障碍组（剔除4例冠状动脉面积狭窄<75%且μQFR≤0.8的患者），所有患者均接受心磁图检查。收集两组患者的基本资料。选取同期115例健康受试者（正常对照组），分析三组患者的心磁图参数差异。心磁图分析参数包括磁极离散度-S波峰（dis-S）；磁偶极子中心轨迹分布QR段（QR-center）、RS段（RS-center）、T波段（TT-center）；描述磁极离心率变化情况的参数—负磁极离心率最大值-QR段（QR-enma）；描述心磁图RS段的参数包括心磁矢量最大逆时针转动角度-RS段（RS-nm）、心磁矢量总转角-RS段（rsa）；描述心磁图T波段的参数包括磁偶极距最大值-T波段（TT-didma）、磁偶极距均方差-T波段（TT-didmse）、磁偶极子中心移动距离-T波段（TT-dicd）、磁偶极子中心移动面积-T波段（TT-dicar）、心磁矢量跳转角度和-T波段（TT-r）等。结果 三组患者的dis-S、QR-center、RS-center、TT-center、QR-enma、RS-nm及TT-didma等18个参数比较，差异有统计学意义（P<0.05）。对于单因素分析中提示差异有统计学意义的参数，在阻塞性冠心病组和冠状动脉微循环障碍组间进行比较，结果提示冠状动脉微循环障碍组的参数QR-center（0.45 vs. 0.07,P<0.001）、RS-center（0.24 vs. -0.15， P<0.001）、TT-center（0.44 vs 0.15,P=0.001）和RS-nm（-77.75 vs. -58.80,P=0.018）均显著小于阻塞性冠心病组。结论 阻塞性冠心病和冠状动脉微循环障碍患者的心磁图信号存在参数差异，这些参数在诊断冠状动脉微循环功能障碍中具有潜在价值。更多还原

【Abstract】 Objective To screen high-sensitivity parameters of magnetocardiography (MCG) for the diagnosis of coronary microvascular dysfunction (CMD).Methods The patients (n=290) admitted due to angina pectoris (AP) were selected from the First Medical Center of Chinese PLA General Hospital from Sept.2022 to Mar.2024.The patients underwent coronary angiography,analysis of Murray-law-based quantitative flow ratio (μQFR),and coronary angiography-derived microcirculatory resistance (AMR).Patients with coronary artery stenosis ≥75% and ≤90% in vessel area and μQFR ≤0.8 were included in the obstructive coronary artery disease group (OCA group).Patients with coronary artery stenosis <75% in vessel area,μQFR >0.8,and AMR >2.5 mmHg·s/cm were included in CMD group (4 patients with coronary artery stenosis <75% and μQFR ≤0.8 were excluded).All patients received MCG examinations.The general data were collected in both groups.The contemporaneous health volunteers (n=115) were selected into normal control group.The differences in MCG parameters were analyzed in all groups.The parameters for MCG analysis included: magnetic pole dispersion-S wave peak (dis-S),magnetic dipole center trajectory distribution in QR segment (QR-center),RS segment (RS-center),and T wave segment (TT-center).The parameter describing the change in magnetic pole eccentricity was maximum negative magnetic pole eccentricity in QR segment (QR-enma).The parameters describing RS segment of MCG included the maximum counterclockwise rotation angle of magnetocardiographic vector (MCGV) in RS segment (RS-nm) and the total rotation angle of MCGV in RS segment (rsa).The parameters describing T wave segment of MCG included the maximum magnetic dipole moment in T wave segment (TT-didma),mean square error of magnetic dipole moment in T wave segment (TT-didmse),the moving distance of magnetic dipole center in T wave segment (TT-died),the moving area of magnetic dipole center in T wave segment (TT-dicar),and the jump angles of MCGV in T wave segment (TT-r),etc.Results The comparison in 18 parameters,including dis-S,QR-center,RS-center,TT-center,QR-enma,RS-nm,TT-didma and so on,showed that the differences had statistical significance in 3 groups.The comparison in parameters with statistically significant differences in single-factor analysis showed that QR-center (0.45 vs.0.07,P<0.001),RS-center (0.24 vs.-0.15,P<0.001),TT-center (0.44 vs.0.15,P=0.001) and RS-nm (-77.75 vs.-58.80,P=0.018) all were significantly lower in OCA group than those in CMD group.Conclusion There are parameter differences in MCG signals between OCA patients and CMD patients,and these parameters have potential value in diagnosing CMD.更多还原