B型脑钠肽和超声心功能对肺动脉高压所致右心衰竭的诊断及预后价值研究
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摘要
目的肺动脉高压所致右心衰竭是一种常见病,且致残率和病死率均很高,本研究拟评估超声心动图与B型脑钠肽对该人群的诊断及预后效能。方法自2017年1～12月入选50例于本院就诊的所致右心衰竭的患者,同时入选单纯左心衰患者50例为对照组。对入选患者进行4周随访,通过ROC曲线评估超声功能与BNP单独及联合对于PAH所致右心衰竭诊断及预后预测效能。结果两组患者一般基本资料差异无统计学意义(P> 0.05)。右心功能不全组BNP水平较高,而右室射血分数(RVEF)水平较低,差异有统计学意义(P <0.05)。通过ROC曲线显示RVEF与BNP曲线下面积(AUC)分别为0.674(95%CI0.542～0.805,P=0.010), 0.669(95%CI 0.530～0.807,P=0.013),RVEF与BNP两者对肺动脉高压所致右心衰竭诊断效能尚可,但两变量之间AUC差异无统计学意义(P>0.05),RVEF联合BNP的AUC为0.741,差异有统计学意义(95%CI 0.613～0.869,P <0.05),诊断效能比单独使用BNP与RVEF高,差异有统计学意义(P <0.05)。1年随访终点事件有18例(17.6%),ROC曲线显示BNP与心脏超声联合对肺动脉高压所致右心衰竭预测效能高于单独使用BNP或心脏超声。结论 BNP和超声心功能对肺动脉高压所致右心衰竭的诊断和预后判断是简便可行的。
Objective To evaluate the efficacy of echocardiography and B-type natriuretic peptide(BNP) in the diagnosis and prognosis of right heart failure caused by pulmonary hypertension(PAH),and right heart failure caused by pulmonary hypertension(PAH) is a common disease with high morbidity and mortality. Methods 50 cases of patients with induced right heart failure and who treated in our hospital from January 2017 to December 2017 were selected, 50 cases of patients with simple left heart failure were selected as control group. The selected patients were followed up for 4 weeks. The ROC curve was used to evaluate the efficacy of ultrasound function and BNP alone or in combination in the diagnosis and prognosis of right heart failure caused by PAH. Results There was no significant difference in the general data between the two groups(P > 0.05).The BNP level in the right ventricular dysfunction group was high,while the right ventricular ejection fraction(RVEF) level was low, and the difference was statistically significant(P < 0.05).The ROC curves showed that the area under RVEF and BNP curves(AUC) were 0.674(95%CI 0.542-0.805, P=0.010), 0.669(95% CI 0.530-0.807, P=0.013), respectively.The diagnostic efficacy of RVEF and BNP for right heart failure caused by pulmonary hypertension was acceptable, but there was no significant difference in AUC between the two variables(P > 0.05).The AUC of RVEF combined with BNP was 0.741, and the difference was statistically significant(95%CI 00.613-0.869, P < 0.05).and the diagnostic efficiency was higher than that of BNP and RVEF alone, and the difference was statistically significant(P < 0.05).There were 18 cases(17.6%) in the 1 year follow-up end-point events. The ROC curves showed that the predictive efficiency of BNP combined with echocardiography for right heart failure caused by pulmonary hypertension was higher than that of BNP or echocardiography alone. Conclusion The diagnosis and prognosis of BNP and echocardiography on right heart failure caused by pulmonary arterial hypertension are simple and feasible.
Objective To evaluate the efficacy of echocardiography and B-type natriuretic peptide(BNP) in the diagnosis and prognosis of right heart failure caused by pulmonary hypertension(PAH),and right heart failure caused by pulmonary hypertension(PAH) is a common disease with high morbidity and mortality. Methods 50 cases of patients with induced right heart failure and who treated in our hospital from January 2017 to December 2017 were selected, 50 cases of patients with simple left heart failure were selected as control group. The selected patients were followed up for 4 weeks. The ROC curve was used to evaluate the efficacy of ultrasound function and BNP alone or in combination in the diagnosis and prognosis of right heart failure caused by PAH. Results There was no significant difference in the general data between the two groups(P > 0.05).The BNP level in the right ventricular dysfunction group was high,while the right ventricular ejection fraction(RVEF) level was low, and the difference was statistically significant(P < 0.05).The ROC curves showed that the area under RVEF and BNP curves(AUC) were 0.674(95%CI 0.542-0.805, P=0.010), 0.669(95% CI 0.530-0.807, P=0.013), respectively.The diagnostic efficacy of RVEF and BNP for right heart failure caused by pulmonary hypertension was acceptable, but there was no significant difference in AUC between the two variables(P > 0.05).The AUC of RVEF combined with BNP was 0.741, and the difference was statistically significant(95%CI 00.613-0.869, P < 0.05).and the diagnostic efficiency was higher than that of BNP and RVEF alone, and the difference was statistically significant(P < 0.05).There were 18 cases(17.6%) in the 1 year follow-up end-point events. The ROC curves showed that the predictive efficiency of BNP combined with echocardiography for right heart failure caused by pulmonary hypertension was higher than that of BNP or echocardiography alone. Conclusion The diagnosis and prognosis of BNP and echocardiography on right heart failure caused by pulmonary arterial hypertension are simple and feasible.
引文
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[7]Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America[J]. J Card Fail,2017,23(8):628-651.
[8]Mehra MR, Park MH, Landzberg MJ, et al. Right heart failure:toward a common language[J]. J Heart Lung Transplant,2014,33(2):123-126.
[9]沈节艳,孙灵跃.右心衰竭诊断和治疗中国专家共识的补充说明[J].中华临床医师杂志(电子版),2013,7(11):15-18.
[10]王吉波,王丽芹.中华结缔组织病相关性肺动脉高压诊治策略的探讨[J].风湿病学杂志,2017,21(9):577-579.
[11]张艳敏,王青松.脑钠肽对急性肺栓塞右心功能不全的临床诊断价值[J].临床肺科杂志,2018,23(6):1094-1097.
[12]宫姝宁,朴商,王玉红,等.N-端脑钠肽前体测定对慢性阻塞性肺疾病及肺心病患者右心功能的评估价值[J].中华肺部疾病杂志(电子版),2014,7(2):66-67.
[13]MahadavanG,NguyenTH,HorowitzJD.Brain natriureticpeptide:abiomarkerforallcardiac disease?[J]. Curr Opin Cardiol,2014,29(2):160-166.
[14]王昕朋,安喆,魏君,等.超声心动图对先心病肺动脉高压(PAH)患者右心功能评价的意义[J].中国实验诊断学,2016,20(6):1019-1021.
[2]肖瑶,朱光发,杨娅,等.超声心动图对慢性阻塞性肺疾病患者早期右心功能异常的评估[J].中华医学超声杂志(电子版),2018,15(3):170-177.
[3]高海叶,王小娟,邓爱云.肺动脉高压患者右心功能超声评估的研究进展[J].医学综述,2018(7):1409-1413.
[4]孟亦真,李劼,马琳,等.超声心动图诊断右心衰竭的判别分析[J].重庆医学,2016,45(27):3838-3840.
[5]Silva MJ, Martins SR, Calisto C, et al. An exploratory panel of biomarkers for risk prediction in pulmonary hypertension:emerging role of CT-proET-1[J]. J Heart Lung Transplant,2013,32(12):1214-1221.
[6]杨冬,刘陶,李蕾,等.妊娠合并心脏病伴肺动脉高压患者妊娠结局分析[J].心肺血管病杂志,2012,31(4):437-439.
[7]Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America[J]. J Card Fail,2017,23(8):628-651.
[8]Mehra MR, Park MH, Landzberg MJ, et al. Right heart failure:toward a common language[J]. J Heart Lung Transplant,2014,33(2):123-126.
[9]沈节艳,孙灵跃.右心衰竭诊断和治疗中国专家共识的补充说明[J].中华临床医师杂志(电子版),2013,7(11):15-18.
[10]王吉波,王丽芹.中华结缔组织病相关性肺动脉高压诊治策略的探讨[J].风湿病学杂志,2017,21(9):577-579.
[11]张艳敏,王青松.脑钠肽对急性肺栓塞右心功能不全的临床诊断价值[J].临床肺科杂志,2018,23(6):1094-1097.
[12]宫姝宁,朴商,王玉红,等.N-端脑钠肽前体测定对慢性阻塞性肺疾病及肺心病患者右心功能的评估价值[J].中华肺部疾病杂志(电子版),2014,7(2):66-67.
[13]MahadavanG,NguyenTH,HorowitzJD.Brain natriureticpeptide:abiomarkerforallcardiac disease?[J]. Curr Opin Cardiol,2014,29(2):160-166.
[14]王昕朋,安喆,魏君,等.超声心动图对先心病肺动脉高压(PAH)患者右心功能评价的意义[J].中国实验诊断学,2016,20(6):1019-1021.