三维斑点追踪技术预测急性心肌梗死患者近期急性心衰风险的研究  

Predictive study of 3D speckle tracking technique for the risk of recent acute heart failure in patients with AMI

作　　者：曾伟 高辰玮[2] 李学永 ZENG Wei;GAO Chen-wei;LI Xue-yong(The First Ward Region of Cardiology of Heart and Kidney Internal Medicine,The 81th Group Military Hospital of PLA,Zhangjiakou 075000,China;不详)

机构地区：[1]解放军陆军第81集团军医院心肾内科心脏一病区,河北张家口075000 [2]河北北方学院附属第一医院超声医学科,河北张家口075000

出　　处：《中国医学装备》2021年第4期92-96,共5页China Medical Equipment

基　　金：河北省2020年度医学科学研究课题计划(20200200)“超声研究昼夜节律改变对老年高血压患者心血管靶器官的影响”;张家口市2020年度市级科技计划(2021086D)“急性心肌梗死患者经皮冠状动脉介入治疗术后早期心功能的超声评价”。

摘　　要：目的:分析三维斑点追踪技术预测急性心肌梗死(AMI)患者近期发生急性心衰的诊断价值。方法:选取医院诊治的155例AMI患者,均予抗血小板聚集、改善心肌供血等对症治疗,并对患者出院后进行为期3个月的随访,除3例患者失联外,将剩余152例患者纳入随访结果研究。将152例患者中出现急性心力衰竭的43例患者纳入心衰组,未出现心力衰竭的109例患者纳入无心衰组。比较两组患者的年龄、性别等一般资料,并对患者N-末端脑钠肽前体(NT-pro BNP)、超敏C反应蛋白(hs-CRP)、肌钙蛋白I(cTnI)等临床常用指标及三维斑点相关指标进行比较。结果:心衰组患者的年龄、NT-proBNP、hs-CRP、c Tn I及左室收缩末期容积指数(LVESVI)均明显高于无心衰组,差异有统计学意义(t=2.279,t=3.385,t=2.212,t=2.943,t=2.289;P<0.05),射血分数(EF)、左室整体径向应变(GRS)、整体圆周应变(GCS)、整体纵向应变(GLS)及整体面积应变(GAS)明显低于无心衰组,差异有统计学意义(t=6.606,t=2.804,t=2.945,t=7.226,t=2.687;P<0.05);而两组患者的性别、合并高血压等一般资料及肾小球滤过率(e GFR)、LVEDVI等指标间差异均无统计学意义;多因素logistic分析提示,NT-pro BNP、LVESVI是影响急性心衰的独立危险因素(OR=1.002,OR=1.118;P<0.05),EF、GLS则是其独立保护因素(OR=0.795,OR=0.452;P<0.05);受试者工作特征(ROC)曲线提示GLS预测急性心衰的ROC曲线下面积(AUC)为0.881,显著高于NT-pro BNP、LVESVI及EF(Z=2.751,Z=3.107,Z=2.895;P<0.05),其诊断的最佳截点<13.42%,此时其灵敏度为95.3%,特异度为67.9%。结论:三维斑点追踪技术可以对急性AMI患者近期发生急性心衰进行有效地预测,具有较高的灵敏性及诊断效能,可以应用于急性AMI患者心衰的早期预测。Objective:To analyze the diagnostic value of three-dimensional(3 D)speckle tracking technique to predict the recent occurrence of acute heart failure in patients with acute myocardial infarction(AMI).Methods:155 patients with AMI who were diagnosed and treated in hospital were selected,and all of them received symptomatic treatments included anti-platelet aggregation and improving myocardial blood supply.And the patients were followed up for a period of 3 months after discharge.Among the 155 patients,3 patients lost contact during the follow-up process,and were treated as shedding.The residue 152 patients were brought into follow-up results for researching.According to the results of follow-up about the 152 patients,the patients with acute heart failure were divided into the heart failure group(43 cases),and the patients without heart failure were divided into none heart failure group(109 cases).The general information of the two groups of patients,such as age and gender,were compared,and the N-terminal pro-brain natriuretic peptide(NT-proBNP),hypersensitivity C-reactive protein(hs-CRP),troponin I(cTnI)and other commonly clinical indicators and 3 D spot related indicators were further compared.Results:The age,NT-proBNP,hs-CRP,cTnI and left ventricular end-systolic volume index(LVESVI)of patients in the heart failure group were significantly higher than those in the none heart failure group,and the difference of each indicator was statistically significant(t=2.279,t=3.385,t=2.212,t=2.943,t=2.289,P<0.05),respectively.And the ejection fraction(EF),left ventricular global radial strain(GRS),global circumferential strain(GCS),global longitudinal strain(GLS)and global area strain(GAS)in the heart failure group were significantly lower than those in the none heart failure group(t=6.606,t=2.804,t=2.945,t=7.226,t=2.687,P<0.05),respectively.However,there were no significant difference between the two groups of patients in general information included gender,combined hypertension and other indicators such as glomerular filt

关 键 词：三维斑点追踪技术 急性心肌梗死(AMI) 急性心衰 受试者工作特征(ROC)曲线 

分 类 号：R542.2[医药卫生—心血管疾病]