基于超声心动图测量的标准化肺动脉指数对法洛四联症根治术患者预后的预测价值  

Application of standardized pulmonary indexes based on echocardiography to predict the prognosis of repaired tetralogy of Fallot

作　　者：赖晓玥 蒋欢 邓曦 夏红梅 LAI Xiaoyue;JIANG Huan;DENG Xi;XIA Hongmei(Department of Ultrasound,Xinqiao Hospital,Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第二附属医院超声科,重庆市400038

出　　处：《临床超声医学杂志》2021年第2期91-95,共5页Journal of Clinical Ultrasound in Medicine

基　　金：陆军军医大学第二附属医院军事临床医学创新技术项目(2018JSLC0032);重庆市社会事业与民生保障科技创新专项重点研发项目(cstc-2017shms-zdyfX0017)。

摘　　要：目的应用超声心动图测量标准化肺动脉指数,探讨其在预测法洛四联症(TOF)根治术患者预后中的临床价值。方法回顾性分析在我院行TOF根治术的465例患者资料,术前应用超声心动图测量并计算肺动脉瓣环Z值(PVAZ)、肺动脉主干Z值(MPAZ)及Nakata指数。绘制受试者工作特征(ROC)曲线预测TOF患者术中是否行跨瓣环补片(TAP),并计算敏感性、特异性、曲线下面积(AUC)及95%可信区间(CI)。采用Spearman相关性分析法分析PVAZ、MPAZ及Nakata指数与围术期临床指标的相关性;利用ROC曲线确定参数的截断值,按截断值分组后分别进行Log-Rank检验比较组间生存差异并绘制Kaplan-Meier生存曲线。结果465例行TOF根治术的患者中,413例(88.82%)术中行TAP。行TAP患者PVAZ小于未行TAP患者[-2.81(-3.31,-2.04)vs.-1.51(-2.52,-0.75)],差异有统计学意义(P<0.001)。ROC曲线分析显示,PVAZ截断值为-2.73,预测术中行TAP的曲线下面积为0.740(95%CI:0.641~0.839),敏感性为52.8%,特异性为86.0%。PVAZ、MPAZ及Nakata指数与围术期临床指标均呈负相关。随访期间共23例死亡(4.95%),中位随访时间为2.03年。ROC曲线分析显示,PVAZ、MPAZ预测患者术后生存的截断值分别为-2.98、-3.47,PVAZ<-2.98者术后生存率显著低于PVAZ≥-2.98者,MPAZ<-3.47者术后生存率显著低于MPAZ≥-3.47者,差异均有统计学意义(P=0.044、0.002)。结论基于超声心动图测量的标准化肺动脉指数是评价TOF根治术患者预后的良好预测指标,对临床危险分层具有一定的指导意义。Objective To explore the value of standardized pulmonary indexes based on echocardiography in the prediction of the prognosis of repaired tetralogy of Fallot(TOF).Methods The data of 465 patients with TOF in our hospital were retrospectively analyzed.The pulmonary valve annulus Z-score(PVAZ),main pulmonary artery Z-score(MPAZ)and Nakata index were calculated by preoperative echocardiography.Receiver operating characteristic(ROC)curve was drawn to predict the practice of trans-annular patch(TAP),sensitivity,specificity,area under curve(AUC)and 95%confidence interval(CI)were calculated.Spearman correlation analysis was used to analyze the correlation between PVAZ,MPAZ,Nakata index and perioperative clinical indicators.ROC curve was used to determine the cut-off value of parameters.Log-Rank was used to compare the survival differences between groups and Kaplan-Meier survival curve were drawn.Results Among the 465 TOF cases,a total of 413 cases(88.82%)underwent TAP during complete repair.PVAZ of the TAP patients was significantly smaller than that of non-TAP patients[-2.81(-3.31,-2.04)vs.-1.51(-2.52,-0.75)],there was significant difference(P<0.05).ROC curve analysis showed the cut-off value of PVAZ for the practice of TAP was-2.73,AUC was 0.740(95%CI:0.641~0.839),sensitivity was 52.8%,specificity was 86.0%.PVAZ,MPAZ and Nakata index were negatively related to the perioperative results.There were 23 cases(4.95%)of death during a median follow-up time of 2.03 years.The cut-off values of PVAZ and MPAZ for postoperative survival were-2.98 and-3.47,respectively.The survival rate between PVAZ<-2.98 patients and PVAZ≥-2.98 patients,MPAZ<-3.47 patients and MPAZ≥-3.47 patients were both statistically significant(P=0.044,0.002).Conclusion Standardized pulmonary indexes based on echocardiographic evaluation is a good indicator to predict the prognosis of repaired TOF,which may be of great guiding significance in the clinical hazard stratification.

关 键 词：超声心动描记术 法洛四联症 肺动脉指数 Z值 

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