肺部超声“彗尾征”对舒张性心力衰竭的诊断价值  

Value of ultrasonic lung comets in diagnosis of diastolic heart failure

作　　者：聂昆[1] 吴文[2] 孟军[3] 李敏[2] 陈涛[2] 张毅[2] 张家新[3] 

机构地区：[1]三峡大学第三临床医学院葛洲坝集团中心医院超声医学科,湖北省宜昌市443000 [2]三峡大学第三临床医学院葛洲坝集团中心医院重症医学科,湖北省宜昌市443000 [3]三峡大学第三临床医学院葛洲坝集团中心医院心血管内科,湖北省宜昌市443000

出　　处：《临床超声医学杂志》2016年第5期308-311,共4页Journal of Clinical Ultrasound in Medicine

基　　金：三峡大学青年科研基金资助项目(KJ2014A016)

摘　　要：目的探讨肺部超声对舒张性心力衰竭患者的临床诊断价值。方法对98例门诊舒张性心力衰竭患者行肺部超声检查并计算"彗尾征"(ULCs)数量,根据ULCs数量分为ULCs≤12条组(33例)和ULCs>12条组(65例),并行胸部X光检查,Boston心力衰竭评分,超声心动图测量二尖瓣舒张早期血流峰速与二尖瓣环舒张早期运动峰速比值(E/Ea),测量N-末端B型钠尿肽前体(NT-pro BNP)水平。以NT-pro BNP≥1000 ng/L、E/Ea≥15及二者联合作为诊断舒张性心力衰竭的3种标准,分别绘制ROC曲线分析肺部超声对心力衰竭的诊断效能。结果 ULCs与NT-pro BNP水平、E/Ea值均呈正相关(r=0.800、0.627,均P<0.01)。使用NT-pro BNP≥1000 ng/L联合E/Ea≥15作为诊断舒张性心力衰竭的标准,ROC曲线显示ULCs截断值为12条时曲线下面积为0.861、敏感性为82.02%、特异性为90.91%,优于Boston心力衰竭评分标准(曲线下面积0.703、敏感性48.28%、特异性85.00%)。与ULCs≤12组比较,ULCs>12组的NT-pro BNP、Boston心力衰竭评分及E/Ea明显升高,差异均有统计学意义(均P<0.01)。结论肺部超声可作为诊断门诊舒张性心力衰竭的有效方法;以ULCs截断值为12可快速而准确地诊断舒张性心力衰竭。Objective To explore the clinical value of lung ultrasound for evaluating diastolic heart failure. Methods Ninety -eight patients with diastolic heart failure were enrolled in this study.All patients underwent lung ultrasonography,and the number of lung comets （ULCs） was recorded. According to the number of ULCs,these patients were divided into two groups,the ULCs ≤12 （33 patients）and ULCs 〉12 （65 patients）. Then these patients received chest X-ray, Boston criteria,mitral inflow E wave to early diastolic mitral annulus velocities ratio （E/Ea） by echocardiography,and amino-terminal B type natriuretic peptide （NT-proBNP） was testd.ROC curve was plotted to analyze the lung ultrasound in predicting diastolic heart failure according to NT-pro BNP≥1000 ng/L,E/Ea≥15 and their combining as three criteria. Results ULCs were significantly positively correlated with NT-proBNP and E/Ea（r=0.800, 0.627,all P〈0.01）.Using the reference of combined E/Ea≥15 with NT-proBNP≥1000ng/L as the diagnostic criteria for diastolic heart failure,ROC curve showed the optimal critical value of ULCs was 12,the area under ROC curve was 0.861,the sensitivity was 82.02%,and specificity was 90.91%,which was better than Boston criteria,which area under ROC curve was 0.703,the sensitivity was 48.28% ,and specificity was 85.00% . Compared with the group of ULCs≤12,the NT-proBNP,Boston criteria and E/Ea were significantly higher than those of group of ULCs〉12,there was significant difference（all P〈0.01）. Conclusion Lung ultrasound is an effective tool for outpatient to predict the cardiac origin of dyspnea for heart failure. A ULCs =12 cutoff could be considered for a quick and reliable assessment of diastolic heart failure.

关 键 词：超声检查 肺 血流峰值流速 N-末端B型钠尿肽前体 心力衰竭 舒张性 

分 类 号：R541.6[医药卫生—心血管疾病] R540.45[医药卫生—内科学]