血清指标联合超声检查指标对慢性心力衰竭的诊断价值分析  

Diagnostic Value of Serum Indexes Combined with Ultrasonic Examination Indexs for Chronic Heart Failure

作　　者：黄冬梅 黄刚[1] 余冬梅[1] 赵躬英 HUANG Dongmei;HUANG Gang;YU Dongmei;ZHAO Gongying(Department of Cardiology,Suining Central Hospital,Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院心内科,629000

出　　处：《实用心脑肺血管病杂志》2021年第11期16-20,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：四川省科技创新苗子工程资助项目(2020080)。

摘　　要：背景慢性心力衰竭(CHF)是常见的心血管疾病,患者预后差、病死率高,已受到世界广泛关注。早期诊断、评估对于改善患者预后具有重要意义。血清指标以及超声检查指标是临床诊断CHF的重要手段,但单独检测缺乏特异性。目的探究血清指标联合超声检查指标对CHF的诊断价值。方法选取2019年5月至2021年4月在遂宁市中心医院接受治疗的CHF患者107例〔纽约心脏病协会(NYHA)分级:Ⅱ级32例,Ⅲ级39例,Ⅳ级36例〕为观察组,另选取同期于遂宁市中心医院体检的健康者100例为对照组。比较两组患者血清指标{肝细胞生长因子(HGF)、B型利钠肽(BNP)、同型半胱氨酸(Hcy)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a〔Lp(a)〕、总胆固醇(TC)、三酰甘油(TG)}、超声检查指标〔左心室射血分数(LVEF)、室间隔厚度(IVST)〕。绘制受试者工作特征(ROC)曲线以评估各指标及其联合对CHF的诊断价值。结果观察组HGF、BNP、Hcy、Lp(a)高于对照组,LVEF低于对照组(P<0.05)。NYHA分级为Ⅲ级的CHF患者HGF、BNP高于NYHA分级为Ⅱ级的CHF患者,LVEF低于NYHA分级为Ⅱ级的CHF患者(P<0.05);NYHA分级为Ⅳ级的CHF患者HGF高于NYHA分级为Ⅱ、Ⅲ级的CHF患者,BNP、Hcy、Lp(a)高于NYHA分级为Ⅱ级的CHF患者,LVEF低于NYHA分级为Ⅱ、Ⅲ级的CHF患者(P<0.05)。ROC曲线分析结果显示,HGF、BNP、Hcy、Lp(a)、LVEF及其联合诊断CHF的曲线下面积(AUC)分别为0.876〔95%CI(0.823,0.917)〕、0.878〔95%CI(0.826,0.919)〕、0.875〔95%CI(0.822,0.917)〕、0.785〔95%CI(0.722,0.839)〕、0.756〔95%CI(0.619,0.813)〕、0.982〔95%CI(0.953,0.995)〕。结论在CHF患者中,HGF、BNP、Hcy、Lp(a)明显升高,LVEF明显降低,其联合对CHF有较高的诊断价值。Background Chronic heart failure(CHF) is a common cardiovascular disease, with poor prognosis and high fatality rate, which has attracted extensive attention of the world. Early diagnosis and evaluation are of great significance for improving the prognosis of such patients. The serum indexes and ultrasonic examination indexs is an important means for clinical diagnosis of CHF, but it is lack of specificity. Objective To explore the diagnostic value of serum indexes combined with ultrasonic examination indexs for CHF. Methods A total of 107 patients with CHF treated in Suining Central Hospital from May 2019 to April 2021 were selected as the observation group. Among them, New York Heart Association(NYHA) classification showed 32 cases of grade Ⅱ, 39 cases of grade Ⅲ, and 36 cases of grade Ⅳ. Meanwhile, 100 healthy individuals who received physical examination in the same hospital during the same period were selected as the control group. Serum indexes {hepatocyte growth factor(HGF), B-type natriuretic peptide(BNP), homocysteine(Hcy), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), lipoprotein a [Lp(a) ], total cholesterol(TC), triacylglycerol(TG) } and ultrasonic examination indexs [left ventricular ejection fraction(LVEF), interventricular septal thickness(IVST) ] were compared between the two groups. The receiver operating characteristic(ROC) curve was plotted to evaluate the diagnostic value of these indexes and their combination for CHF. Results HGF, BNP, Hcy, and Lp(a) in the observation group were higher than those in the control group, while LVEF was lower than that in the control group(P < 0.05). Patients with NYHA grade Ⅲ had higher HGF and BNP, and lower LVEF than those with NYHA grade Ⅱ(P < 0.05). Patients with NYHA grade Ⅳ had higher HGF than those with NYHA grade Ⅱ and Ⅲ, higher BNP, Hcy and Lp(a) than those with NYHA grade Ⅱ, lower LVEF than those with NYHA grade Ⅱ and Ⅲ(P < 0.05). ROC curve analysis results showed that the area under cur

关 键 词：心力衰竭 肝细胞生长因子 B型利钠肽 同型半胱氨酸 脂蛋白A 左心室射血分数 诊断 

分 类 号：R541.62[医药卫生—心血管疾病]