肺部超声检查B线评分在急性呼吸困难病因鉴别诊断中的应用  

Application of Lung Sonography B-line Scores in Differential Diagnosis of the Etiology on Acute Dyspnea

作　　者：贾鹏企 李天亮 白鸿晖 韩红 候雪婷 JIA Pengqi;LI Tianliang;BAI Honghui;HAN Hong;HOU Xueting(Department of Ultrasound,Shanxi Cardiovascular Hospital,Taiyuan 030024,China;不详)

机构地区：[1]山西医科大学医学影像学系,山西太原030001 [2]山西省心血管病医院超声科,山西太原030024

出　　处：《中国医学影像学杂志》2020年第9期652-656,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨肺部超声检查B线评分在急性呼吸困难病因鉴别诊断中的应用价值。资料与方法选取因急性呼吸困难住院患者55例,于临床治疗前行肺超声检查计算B线评分、实验室检测血浆N末端-B型脑钠肽前体(NT-proBNP)以及左心房前后径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)等超声心动图参数。由临床医师根据急性左心衰竭诊断标准对纳入患者明确诊断,并分为急性左心衰呼吸困难组(Ⅰ组)和非心衰呼吸困难组(Ⅱ组)。观察两组患者的B线评分、NT-proBNP、超声心动图参数差异,评估肺超声B线评分对心源性呼吸困难的诊断价值。结果与Ⅱ组相比,Ⅰ组患者B线评分、NT-proBNP、LAD、LVEDD、LVESD明显增高,LVEF显著下降,差异均有统计学意义(P<0.01)。Pearson相关分析显示,肺超声B线评分与LAD、LVEDD、LVESD呈正相关(r=0.398、0.352、0.411,P<0.05),与NT-proBNP呈高度正相关(r=0.799,P<0.05),与LVEF呈高度负相关(r=-0.835,P<0.05)。受试者工作特征(ROC)曲线分析表明,肺超声B线评分预测心源性呼吸困难的ROC曲线下面积为0.922(95%CI 0.855~0.989,P<0.01)。肺超声B线评分诊断心源性呼吸困难的最佳临界点为11.5,其敏感度为77.4%、特异度为95.8%。结论肺超声B线评分能为心源性呼吸困难的鉴别诊断提供可靠依据,具有重要的临床应用价值。Purpose To explore the value of lung sonography B-line scores in the differential diagnosis of the etiology on acute dyspnea.Materials and Methods Fifty-five patients hospitalized for acute dyspnea were selected,lung sonography was performed before the clinical treatment to calculate the B-line scores,plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)was determined,and echocardiographic parameters were evaluated including left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF).According to the diagnostic criteria of acute left heart failure,the clinician made a clear diagnosis of the included patients,and divided them into acute left heart failure dyspnea group(group I)and non-heart failure dyspnea group(group II).The difference of B-line score,NT-proBNP and echocardiographic parameters between the two groups were compared,and the diagnostic value of lung sonography B-line scores for cardiogenic dyspnea was evaluated.Results Compared with groupⅡ,the B-line score,NT-proBNP,LAD,LVEDD and LVESD of groupⅠwere significantly increased,and LVEF was significantly decreased(P<0.01).Pearson correlation analysis showed that the lung sonography B-line scores was positively correlated with LAD,LVEDD and LVESD(r=0.398,0.352,0.411,P<0.05),and it was highly positively correlated with NT-proBNP(r=0.799,P<0.05).It was highly negatively correlated with LVEF(r=-0.835,P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve of the lung sonography B-line scores predicting cardiogenic dyspnea was 0.922(95%CI 0.855-0.989,P<0.01).The best cut-off point of lung sonography B-line scores for diagnosis of cardiogenic dyspnea was 11.5,with a sensitivity of 77.4%and a specificity of 95.8%.Conclusion The lung sonography B-line scores can provide a reliable basis for the differential diagnosis of cardiogenic dyspnea,and has important clinical application value.

关 键 词：心力衰竭 呼吸困难 肺水肿 超声检查 多普勒 彩色 超声心动描记术 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.5[医药卫生—诊断学]