心率减速力对心力衰竭严重程度及预后的评估价值  

Value of heart rate deceleration force in evaluating severity degree and prognosis of heart failure

作　　者：孙汝平[1] 张娜[1] 徐金义[1] 廉湘琳 王焕霞[1] SUN Ruping;ZHANG Na;XU Jinyi;LIAN Xianglin;WANG Huanxia(Department of Cardiac Function,Henan Provincial People′s Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院心功能科,郑州450003

出　　处：《重庆医学》2018年第34期4406-4410,共5页Chongqing medicine

基　　金：河南省科技厅科技攻关项目(152102310419)

摘　　要：目的探究心率减速力对比左心室射血分数(LVEF)、纽约心脏病协会(NYHN)分级及N末端脑钠肽(NT-proBNP)对心力衰竭严重程度及预后的评估价值。方法选取该院住院治疗的符合纳入标准的心力衰竭患者136例,入院后完善心率减速力的测定、超声心动图、NT-proBNP等检查,并进行NYHA心功能分级评估,出院后对患者进行随访,根据是否发生主要不良心脏事件分为不良预后组和预后良好组,利用单、多因素筛选导致影响心力衰竭患者预后的独立影响因素,并利用ROC分析各指标潜在的诊断效能。结果随访结果显示患者的不良预后率为37%。糖尿病史(P=0.034)、心功能Ⅲ级(P=0.044)、心功能Ⅳ级(P=0.018)、LVEF(P=0.034)、NT-proBNP(P=0.034)、心率减速力(P=0.034)是影响预后的独立影响因素。心率减速力联合NT-proBNP的AUC最高,灵敏度为87.00%、特异度为78.10%。结论心率减速力联合NT-proBNP对心力衰竭预后有较高预测价值。Objective To explore the evaluation values between the heart rate deceleration(DC)force with LVEF,NYHA classification and NT-proBNP for evaluating the severity and prognosis in the patients with heart failure.Methods One hundred and thirty-six inpatients with heart failure meeting the inclusion standard in our hospital were selected.After admission,the heart rate deceleration force test,echocardiography,NT-proBNP and other laboratory tests were performed.The NYHA cardiac function assessment was performed.The patients were followed up after discharge,and divided into the poor prognosis group and good prognosis according to whether the major adverse cardiac events occurring.The single and multi-factorial analysis were used to screen the independent influencing factors causing the prognosis in the patients with heart failure,and ROC was used to analyze the potential diagnostic efficacy of each index.Results The follow-up results showed that the poor prognosis rate in patient was 37%.The history of diabetes mellitus(P=0.034),cardiac function gradeⅢ(P=0.044),cardiac function gradeⅣ(P=0.018),LVEF(P=0.034),NT-proBNP(P=0.034)and heart DC force(P=0.034)were the independent factors affecting the prognosis.AUC of heart rate DC force combined with NT-proBNP was highest,the sensitivity was 87.00%and the specificity was 78.10%.Conclusion The heart rate DC force combined with NT-proBNP has a higher value to predict the prognosis of the patients with heart failure.

关 键 词：心率减速力 左心室射血分数 NYHA分级 N末端脑钠肽 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]