血清cTnI水平联合肺动脉CT成像、心脏超声评估老年性心力衰竭患者预后的价值研究  

The application value of serum cTnI level combined with pulmonary artery CT imaging and echocardiography in evaluating prognosis of elderly patients with heart failure

作　　者：胡琳 汤春贵 郝丽琴 张明英 HU Lin;TANG Chungui;HAO Liqin(Department of Medical Imaging,The Fourth People’s Hospital of Ya’an City,Sichuan,Yan’an 625000,China)

机构地区：[1]四川省雅安市第四人民医院医学影像科,625000 [2]四川省雅安市第四人民医院内三科,625000 [3]雅安市职业技术学院体检中心

出　　处：《河北医药》2020年第1期24-27,32,共5页Hebei Medical Journal

基　　金：四川省卫生厅科研基金项目(编号:1101265)

摘　　要：目的研究血清心肌钙蛋白I(cTnI)水平联合肺动脉CT成像、心脏超声在评估老年性心力衰竭患者预后判断中的价值。方法选取2016年2月至2018年2月收治的90例心力衰竭患者为研究对象,对患者展开为期5年随访,其中死亡41例,生存患者49例,对2组患者血清cTnI水平、肺动脉CT成像、心脏超声结果进行多因素分析以及ROC曲线研究,分析联合检测对心衰患者的预后评判价值。结果2组患者血清cTnI水平、肺动脉CT成像、心脏超声结果对比:死亡组患者的血清cTnI水平明显高于生存组,差异有统计学意义(P<0.05);肺动脉CT测量中,死亡组患者的LPAD、RPAD明显高于生存组;IVST低于生存组;心脏超声检测中,死亡组患者的LVEDD、AOD、LVM、E/e均高于生存组,RWT、IVST、LVEF、E/A均低于生存组,差异有统计学意义(P<0.05)。血清cTnI水平,肺动脉CT检查中LPAD、RPAD,心脏超声检查中LPAD、RPAD、LVEF与心衰患者的死亡情况呈正相关(r值分别为0.352、0.123、0.431、0.361、0.002、0.176,P<0.05),IVST,心脏超声中E/A、E/e与心衰患者的死亡情况呈现负相关(r值分别为-0.167、-0.723、-0.157,P<0.05)。多因素Logistic回归分析发现血清cTnI水平,肺动脉CT中的LPAD、RPAD、IVST心脏超声中的LVEDD、IVSF、RWT、LVEF、E/A、E/e均为心力衰竭患者死亡的独立危险因素。通过对血清cTnI水平、肺动脉CT成像、心脏超声结果ROC曲线分析,联合检测患者的曲线下面积高于单独检测,联合检测灵敏度高于对照组,差异有统计学意义(P<0.05)。结论血清cTnI水平、肺动脉CT成像、心脏超声结果联合检测对心力衰竭患者的预后评估较为准确,ROC曲线下面面积较高,灵敏度较高,值得在临床推广。Objective To investigate the application value of of serum cTnI level combined with pulmonary artery CT imaging and echocardiography in evaluating prognosis of elderly patients with heart failure.Methods Ninety patients with heart failure who were treated in our hospital from February 2016 to February 2018 were enrolled in the tudy,who were followed up for 5 years,of whom,41 patients died and 49 patients were survived.The serum levels of cTnI,pulmonary artery CT imaging,echocardiography and ROC curves were analyzed.The value of combination detection in in evaluating prognosis of elderly patients with heart failure was analyzed.Results The serum cTnI levels,LPAD and RPAD in death case group were significantly higher than those in survival case group(P<0.05),however,the IVST levels were significantly lower than those in survival case group(P<0.05).Moreover LVEDD,AOD,LVM,E/e in death case group were significantly higher than those in survival case group(P<0.05),but RWT,IVST,LVEF,E/A were significantly lower than those in survival case group(P<0.05).In addition the LPAD,RPAD and LVEF were positively correlated with the mortality of patients with heart failure,however,IVST,E/A and E/e were negatively correlated with the mortality of patients.The multiple factor Logistic regression analysis showed that the serum levels of cTnI,LPAD,RPAD,IVST,LVEDD,IVSF,RWT,LVEF,E/A,E/e were the independent risk factors of death of patients with heart failure.Moreover sensitivity of combination detection was significantly high er than that by simple index detection(P<0.05).Conclusion The combined detection of serum cTnI levels,pulmonary artery CT imaging and echocardiography is more accurate in evaluating the prognosis of patients with heart failure.The area under the ROC curve is higher and the sensitivity is higher,thus,it is worth being popularized in clinical practice.

关 键 词：心肌钙蛋白I 心力衰竭 肺动脉CT 心脏彩超 

分 类 号：R541.61[医药卫生—心血管疾病]