摘要
目的：探讨肺部超声联合N-末端B型钠尿肽前体（ NT-proBNP）对急性呼吸困难的鉴别诊断的临床价值。方法采用前瞻性观察性的研究方法。纳入166例急性呼吸困难患者,行肺部超声检查计算“彗尾征”数量（ULCs）,超声心动图测量左心室射血分数（LVEF）值,测定NT-proBNP水平并进行Boston心力衰竭评分。根据临床医师对患者住院资料和所有检查进行研判的最终诊断作为金标准,将患者分为心源性呼吸困难组和非心源性呼吸困难组。通过Logistic回归分析评价各指标与心源性呼吸困难的关系,构建受试者工作特征曲线（ ROC曲线）分析单用肺部超声和联合NT-proBNP对急性失代偿性心力衰竭（ ADHF）的预测效能。结果与非心源性呼吸困难组比较,心源性呼吸困难组的ULCs、NT-proBNP、Boston心力衰竭评分标准明显升高,LVEF值显著下降,差异有统计学意义（P〈0.01）。相关分析结果显示,ULCs与 NT-proBNP显著正相关（P〈0.01）,ULCs与LVEF显著负相关（P〈0.01）。回归分析结果显示,ULCs水平升高[估计值比值比（OR）1.409,95%可信区间（95%CI）1.147~1.732,P=0.001]是心源性呼吸困难的最重要独立危险因素。应用ROC曲线进一步分析显示,ULCs截断值为16条时诊断心源性呼吸困难的敏感度为82.02%、特异度为89.61%,高于NT-proBNP、Boston心力衰竭评分及LVEF值的预测价值。联合 ULCs和 NT-proBNP共同预测心源性呼吸困难,曲线下面积为0.937,敏感度为82.02%,特异度为90.91%。结论单独使用肺部超声或联合NT-proBNP是鉴别心源性呼吸困难的有效方法。以ULCs≥16条为截断值可快速而准确的诊断ADHF。
Objective The aim of this study was to study the diagnostic accuracy of lung ultrasound combined with N-terminal pro-brain natriuretic peptide （ NT-proBNP） in differentiating cardiogenic dyspneafrom non -cardiogenic dyspnea. Methods This was a prospective, observational study of 166 adult patients admitted with acute dyspnea. All patients underwent lung ultrasoundexaminations（the presence of a comet-tail sign）, left ventricular ejectionfraction（LVEF）by echocardiography examination,NT - proBNP testing and clinical assessment （ according to the Boston criteria） . Two independent physicians reviewed all the medical records to establish the aetiologic diagnosis of dyspnea,served as the criterion standard. The patients were divided into two groups,namely＆amp;nbsp;cardiogenic dyspnea group and non - cardiogenic dyspnea group. The independent risk factors of the cardiogenic dyspnea were analyzed by univariate and multivariable Logistic regression. Receiver operating characteristic curve（ ROC） was plotted to evaluate the value of ultrasound lung comets（ ULCs） alone and combined with NT - proBNP in predicting acute decompensated heart failure （ ADHF ） . Results Compared with non - cardiogenic dyspnea group, the ULCs, NT - proBNP and Boston criteriain cardiogenic dyspnea group were significantly elevated, but LVEF was significantly worse（P 〈0. 01）. Correlation analysis showed ULCs were significantly positively correlated with NT-proBNP（P〈0. 01）, and ULCs significantly negatively correlated with LVEF（P 〈0. 01）. It was shown in the multivariable Logistic regression analysis that ULCs at admission[odds ratio（OR）1. 409, 95% confidence interval （95%CI） 1. 147 ~ 1. 732, P = 0. 001 ] was the most important independent prognostic factors for diagnosing the cardiogenic dyspnea. Receiver operating characteristic （ ROC） showed the optimal critical value of ULCs was 16 lines,the sensitivity was 82. 02%,and specificity was 89. 61%. ULCs was better in predicting the cardiogenic
出处
《中国急救医学》
CAS
CSCD
北大核心
2016年第6期507-512,I0003,共7页
Chinese Journal of Critical Care Medicine
基金
基金项目：三峡大学青年科研基金资助项目（KJ2014A016）
