床旁肺部超声联合血浆氨基末端脑钠肽前体对心力衰竭的诊断价值
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摘要
目的:探讨心力衰竭(心衰)患者肺部超声B线的数量和血浆氨基末端脑钠肽前体(NT-proBNP)浓度对心衰的诊断价值。方法:选取2014年3-9月就诊于苏州大学附属第一医院急诊或住院的心衰患者59例(男39例,女20例),均行床旁超声心动图、肺部超声检查及血浆NT-proBNP浓度的测定。结果:B线数量及血浆NT-proBNP水平随NYHA心功能严重程度而增加,差异有统计学意义(P<0.05)。B线与血浆中NT-proBNP水平呈明显的正相关关系(r=0.65,P<0.01)。B线诊断NYHA心功能Ⅱ级以上心衰的ROC曲线下面积为0.702,NT-proBNP诊断NYHA心功能Ⅱ级以上心衰的ROC曲线下面积为0.685。结论:床旁肺部超声是评估心衰的一种新的手段,联合血浆NT-proBNP水平可提高对心衰的诊断价值。
Objective:To explore the diagnostic value of the concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)in plasma and the number of B lines by lung ultrasound in patients with heart failure.Method:Selected 59 cases(Male 39 cases,female 20 cases)who were diagnosed heart failure in the first affiliated hospital of Soochow University from Mar in 2014 to September in 2014.Echocardiogram was carried out on patients that enrolled in our research,and the number of B lines were detected by lung ultrasound and the concentration of NT-proBNP in plasma were detected.Result:The number of B lines and the concentration of NT-proBNP in plasma strengthens with heart failure serious degree increase significantly(P<0.05).Correlation analysis showed that the number of B lines and the concentration of NT-proBNP in plasma had a positively correlation(r=0.65,P<0.01).The area of ROC curve by B line was 0.702 in the of diagnosis of heart failure aboved NYHA grade Ⅱ.The area of ROC curve by the concentration of NT-proBNP was 0.685 in the of diagnosis of heart failure aboved NYHA gradeⅡ.Conclusion:Lung ultrasound on bedside is a new way to assess heart failure.It combined with the concentration of NT-proBNP in plasma could enhanced the diagnostic value for heart failure.
Objective:To explore the diagnostic value of the concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)in plasma and the number of B lines by lung ultrasound in patients with heart failure.Method:Selected 59 cases(Male 39 cases,female 20 cases)who were diagnosed heart failure in the first affiliated hospital of Soochow University from Mar in 2014 to September in 2014.Echocardiogram was carried out on patients that enrolled in our research,and the number of B lines were detected by lung ultrasound and the concentration of NT-proBNP in plasma were detected.Result:The number of B lines and the concentration of NT-proBNP in plasma strengthens with heart failure serious degree increase significantly(P<0.05).Correlation analysis showed that the number of B lines and the concentration of NT-proBNP in plasma had a positively correlation(r=0.65,P<0.01).The area of ROC curve by B line was 0.702 in the of diagnosis of heart failure aboved NYHA grade Ⅱ.The area of ROC curve by the concentration of NT-proBNP was 0.685 in the of diagnosis of heart failure aboved NYHA gradeⅡ.Conclusion:Lung ultrasound on bedside is a new way to assess heart failure.It combined with the concentration of NT-proBNP in plasma could enhanced the diagnostic value for heart failure.
引文
[1]王吉耀.内科学(上/下册)[M].北京:人民卫生出版社,2010:189-207.
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[5]GHEORGHIADE M,FOLLATH F,PONIKOWSKI P,et al.Assessing and grading congestion in acute heart failure:a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine[J].Eur J Heart Fail,2010,12:423-433.
[6]焦荣红,曲艺,董军杰,等.超声心动图综合评价慢性心力衰竭心脏功能的应用价值[J].河北医药,2011,33(24):3767-3768.
[7]KOGLIN J,PEHLIVALI S,SEHWAIBLMAIR M,et al.Role of brain natriurefie in risk stratication of patients with congestive heart failure[J].J Am Coil Cardiol,2001,38:1934-1941.
[8]NIELS L B,MAISEL A S.Natriuretic peptides[J].J Am Coil Cardiol,2007,50:2357-2368.
[9]LICHTENSTEIN D A,MEZIERE G A.A-lines and B-lines:lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill[J].Chest,2009,136:1014-1020.
[10]LICHTENSTEIN D A,MEZIERE G A.Relevance of lung ultrasound in the diagnosis of acute respiratory failure:the BLUE protocol[J].Chest,2008,134:117-125.
[11]MIGLIORANZA M H,GARGANI L.Lung ultrasound for the evaluation of pulmonary congestion in outpatients:a comparison with clinical assessment,natriuretic peptides,and echocardiography[J].JACC Cardiovasc Imaging,2013,6:1141-1151.
[2]GARGANI L,FRASSI F.Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea:a comparison with natriuretic peptides[J].Eur J Heart Fail,2008,10:70-77.
[3]FRASSI F,GARGANI L,GLIGOROVA S,et al.Clinical and echocardiographic determinants of ultrasound lung comets[J].Eur J Echocardiogr,2007,8:474-479.
[4]LICHTENSTEIN D A.Lung ultrasound in the critically ill[J].Ann Intensive Care,2014,4:1-2.
[5]GHEORGHIADE M,FOLLATH F,PONIKOWSKI P,et al.Assessing and grading congestion in acute heart failure:a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine[J].Eur J Heart Fail,2010,12:423-433.
[6]焦荣红,曲艺,董军杰,等.超声心动图综合评价慢性心力衰竭心脏功能的应用价值[J].河北医药,2011,33(24):3767-3768.
[7]KOGLIN J,PEHLIVALI S,SEHWAIBLMAIR M,et al.Role of brain natriurefie in risk stratication of patients with congestive heart failure[J].J Am Coil Cardiol,2001,38:1934-1941.
[8]NIELS L B,MAISEL A S.Natriuretic peptides[J].J Am Coil Cardiol,2007,50:2357-2368.
[9]LICHTENSTEIN D A,MEZIERE G A.A-lines and B-lines:lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill[J].Chest,2009,136:1014-1020.
[10]LICHTENSTEIN D A,MEZIERE G A.Relevance of lung ultrasound in the diagnosis of acute respiratory failure:the BLUE protocol[J].Chest,2008,134:117-125.
[11]MIGLIORANZA M H,GARGANI L.Lung ultrasound for the evaluation of pulmonary congestion in outpatients:a comparison with clinical assessment,natriuretic peptides,and echocardiography[J].JACC Cardiovasc Imaging,2013,6:1141-1151.