摘要
目的探讨肺超声联合超声心动图快速诊断心源性呼吸困难的应用价值。方法选取2019年11月至2021年3月于大连大学附属中山医院因急性呼吸困难收入院的患者162例,根据诊断结果分为肺源性呼吸困难组(Ⅰ组,79例)和心源性呼吸困难组(Ⅱ组,83例)。所有患者于入院后治疗前进行肺超声检查,测量B线总数;同时行超声心动图检查,测量左心房内径(LA)、左室舒张末期内径(LVEDD)、射血分数(LVEF)、二尖瓣口舒张早期血流速度(E)与二尖瓣环舒张早期运动速度(E’)之比(E/E’);测定血浆N末端脑钠肽(NT-proBNP)浓度。采用独立样本t检验比较两组之间差异,Pearson相关分析法分析B线总数与LA、LVEDD、LVEF、E/E’、NT-proBNP之间的相关性。绘制B线总数及NT-proBNP的ROC曲线,比较曲线下面积(AUC),评价和比较B线总数与NT-proBNP诊断心源性呼吸困难的敏感性、特异性和准确性,并选择各变量的最佳诊断分界值。结果Ⅰ组患者的B线总数、LA、LVEDD、E/E’值及NT-proBNP值均低于Ⅱ组[(6.92±2.26)条比(18.43±4.58)条,(35.65±2.04)mm比(42.20±3.29)mm,(47.62±1.67)mm比(54.47±3.10)mm,(7.47±1.98)比(16.78±7.83),(391.01±366.98)ng/L比(4655.71±4569.51)ng/L,P<0.01],而LVEF值高于Ⅱ组[(60.33±2.06)%比(43.22±3.55)%,P<0.01],两组差异均有显著统计学意义。两组患者的B线总数与LA、LVEDD、NT-proBNP值、E/E’呈线性正相关(r=0.690,P<0.01;r=0.686,P<0.01;r=0.549,P<0.01;r=0.407,P<0.01),与LVEF呈负相关(r=-0.805,P<0.01)。ROC曲线分析显示,用B线总数来诊断心源性呼吸困难,曲线下面积(AUC)为0.978,敏感度为89.2%,特异度为90.0%,准确度为89.5%,最佳诊断分界值为9条;用NT-proBNP来诊断心源性呼吸困难,AUC为0.958,敏感度为79.5%,特异度为87.0%,准确度为71.0%,最佳诊断分界值为2305 ng/L。用B线总数来诊断心源性呼吸困难的敏感性、特异性和准确性均高于NT-proBNP。结论 B线总数对心源性呼吸困难具有较高的诊断价值,肺超声联合超声心动图有助于临床快速鉴别诊断心源性呼吸困难,值得推广应用。
Objective To explore the application value of lung sonography combined with echocardiography in rapid diagnosis of cardiogenic dyspnea. Methods A totle of 162 patients admitted to Affiliated Zhongshan Hospital Dalian University from November 2019 to March 2021 due to acute dyspnea were selected and divided into pulmonary dyspnea group(group Ⅰ, 79 cases) and cardiogenic dyspnea group(group Ⅱ,83 cases). All patients were examined by lung sonography after admission and before treatment to measure the total number of B-lines. Meanwhile, echocardiography was performed to measure left atrial diameter(LA), left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF) and the ratio of early diastolic flow velocity(E) of mitral orifice to early diastolic motion velocity(E’). Plasma N-terminal probrain natriuretic peptide(NT-pro BNP) was measured. Independent sample T test was used to compare the differences between the two groups and Pearson correlation analysis was used to analyze the correlation between the total number of B-lines and LA, LVEDD, LVEF, E/E’, NT-pro BNP. Draw the ROC curves of total number of B-lines and NT-pro BNP, the areas under the curves(AUC) were compared;the sensitivity, specificity and accuracy of the total number of B lines and NT-pro BNP in the diagnosis of cardiogenic dyspnea were evaluated and compare;and the best diagnostic cut-off value of each variable was selected. Results The total number of B-lines, LA,LVEDD, E/E’ and NT-pro BNP of group Ⅰ were all lower than those of group Ⅱ [(6.92±2.26) vs.(18.43±4.58),(35.65 ± 2.04)mm vs.(42.20 ± 3.29)mm,(47.62 ± 1.67)mm vs.(54.47 ± 3.10)mm,(7.47 ± 1.98) vs.(16.78 ± 7.83),(391.01±366.98)ng/L vs.(4655.71±4569.51)ng/L, P<0.01], while LVEF was higher than that of group Ⅱ [(60.33±2.06)% vs.(43.22±3.55)%, P<0.01], and the difference between the two groups was statistically significant. The total number of B-lines was positively correlated with LA, LVEDD, NT-pro BNP and E/E’(r=0.690, P<0.01;r=0.686, P<0.01;r=0.549, P<0.01;r=0.407, P<0.01), and negatively correlated with LVEF(r=-0.805, P<0.01) in2 groups. ROC curve analysis showed that the AUC of the total number of B-lines for the diagnosis of cardiogenic dyspnea was 0.978, with a sensitivity of 89.2%, a specificity of 90.0% and an accuracy of 89.5%. The best diagnostic cut-off value was 9. Using NT-pro BNP to diagnose cardiogenic dyspnea, the AUC was 0.958, with a sensitivity of 79.5%, specificity of 87.0% and accuracy of 71.0%;the best diagnostic cut-off value was 2305 ng/L.The sensitivity, specificity and accuracy of the total number of B-lines in the diagnosis of cardiogenic dyspnea were higher than those of NT-pro BNP. Conclusion The total number of B-lines has high diagnostic value for cardiogenic dyspnea. Lung sonography combined with echocardiography is helpful to the rapid clinical diagnosis of cardiogenic dyspnea, which is worth popularizing and applying.
作者
刘月
郭丽苹
尹丽
杨爽
赵之
LIU Yue;GUO Li-ping;YIN Li;YANG Shuang;ZHAO Zhi(Department of Ultrasound,Affiliated Zhongshan Hospital Dalian University,Dalian 116000,China)
出处
《中国心血管病研究》
CAS
2022年第2期128-132,共5页
Chinese Journal of Cardiovascular Research
基金
大连市医学科学研究计划项目(2011042)。
