心脏超声参数积分系统对慢性左心室收缩功能减低心力衰竭患者一年再入院的风险评估  

Risk Assessment of Echocardiography Parameter Scoring System for 1 Year Re-admission in Patients With Left Ventricular Systolic Dysfunction

作　　者：翟春晓 王晓军[2] 余永明 王艺丹 徐良栋 丛晓[5] 申晓倩 李虹[2] 梁英[2] 郝恩魁[2] 

机构地区：[1]潍坊医学院临床医学院,山东省潍坊市261053 [2]山东大学附属千佛山医院心内科 [3]山东大学 [4]德州市人民医院急诊科 [5]济南市中心医院心内科 [6]烟台毓璜顶医院神经外科监护室

出　　处：《中国循环杂志》2017年第12期1194-1198,共5页Chinese Circulation Journal

基　　金：2014年山东省科技发展计划(2014GSF118187)

摘　　要：目的:本研究旨在建立并使用心脏超声参数积分系统(超声积分系统)对慢性左心室收缩功能减低(LVSD)心力衰竭(心衰)患者进行1年再入院风险评估。方法:收集并整理我院2007-01至2016-01期间连续9年慢性LVSD患者412例,以1年内再入院为本研究终点。412例患者常规超声心动图检查数据包括2007-01至2014-12用于建立超声积分系统280例,2015-01至2016-01用于超声积分系统的验证132例。依据采集的7项指标并分组:(1)左心室内径:0组(n=290)和1组(n=122);(2)二尖瓣反流:0组(n=203)、1组(n=138)和2组(n=71);(3)三尖瓣反流:0组(n=302)、1组(n=90)和2组(n=20);(4)LVEF:0组(n=272)和1组(n=140);(5)肺动脉收缩压:0组(n=282)和1组(n=130);(6)心包积液:0组(n=347)和1组(n=65);(7)胸腔积液:0组(n=261)、1组(n=86)和2组(n=65)。使用COX回归分析对超声参数进行筛查,并通过风险因子(HR)计算超声积分系统权重值,利用超声积分系统对LVSD患者1年内再入院进行分析,并与传统超声参数进行受试者工作特征(ROC)曲线分析比较。最后通过验证数据集对超声积分系统进行验证。结果:超声积分系统分值如下:左心室内径>60 mm=1分,三尖瓣反流1组=1分,三尖瓣反流2组=3分,二尖瓣反流1组=2分,二尖瓣反流2组=4分,胸腔积液1组=2分,胸腔积液2组=3分,心包积液=1分。超声积分系统COX回归分析发现,不同组间LVSD患者1年内再入院率的HR分别为1.552、3.347、4.562,组间比较差异有统计学意义(P<0.05)。超声积分系统的预测能力采用ROC曲线下面积(AUC)进行评价(建模数据:70.0%,95%CI:0.640~0.761;验证数据:70.4%,95%CI:0.616~0.792),最佳积分阈值为4分。结论:超声积分系统能够很好的预测LVSD患者1年再入院风险,并优于传统单项超声参数。Objective： To establish an echocardiography parameter scoring system for assessing the risk of 1 year re-admission in patients with left ventricular systolic dysfunction （LVSD）. Methods： A total of 412 chronic LVSD patients treated in our hospital from 2007-01 to 2016-01 were studied and the end point event was 1 year re-admission. The data included in 280 patients from 2007-01 to 2014-12 for establishing the scoring system and 132 patients from 2015-01 to 2016-01 for verifying the system. Based on 7 echocardiography parameters, the patients were divided into 7 sets of groups： ① Left ventricular diameter （LVD）： Group0, n=290 and Group1, n=122;② Mitrial regurgitation （MR）： Group0, n=203, Group1, n=138 and Group2, n=71; ③ Tricuspid regurgitation （TR）： Group0, n=302, Group1, n=90 and Group2, n=20; ④ LVEF： Group0, n=272 and Group1, n=140; ⑤ Pulmonary artery systolic pressure： Group0, n=282 and Group1, n=130; ⑥ Hydropericardium： Group0, n=347 and Group1, n=65; ⑦ Hydrothorax：Group 0, n=261, Group1, n=86 and Group2, n=65. The parameters were identified by COX regression analysis, weighted value of scoring system was calculate by hazard ratio （HR）, predictive value for1 year re-admission was assess by ROC curve and finally, scoring integration was verified by validation data group. Results： The integration score was calculated as follows： LVD〉60mm=1 point; TR： Group1=1 point and Group2=3 points; MR： Group1=2 points and Group2=4 points; Hydrothorax： Group1=2 points and Group2=3 points;Hydropericardium=1 point. COX regression analysis indicated that for 1 year re-admission： HR=1.552 in Group1 vs Group0, HR=3.374 in Group2 vs Group0 and HR=4.562 in Group3 vs Group0, all P〈0.05. The AUC of ROC for establishing the data was 70.0% （95% CI 0.640-0.761） and for verifying the data was 70.4% （95% CI 0.616-0.792）; the best integration score was 4 points. Conclusion： Echocardiography parameter scoring system may better predict the risk of 1 year re-admis

关 键 词：超声心动描记术 心室功能障碍 左 COX回归分析 

分 类 号：R541.4[医药卫生—心血管疾病]