左室质量指数联合心功能生化指标对不同病因心功能不全患者的诊断价值  

Diagnostic value of the left ventricular mass index combined with biochemical indicators of cardiac function in patients with cardiac insufficiency of different etiologies

作　　者：陈婷婷 张蓓 李莎 赵丽娜 张燕 贾晓峰 CHEN Tingting;ZHANG Bei;LI Sha;ZHAO Li'na;ZHANG Yan;JIA Xiaofeng(Department of Ultrasound,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Ultrasonography,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Radiology,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院超声科,贵州贵阳550004 [2]贵州医科大学附属医院放射科,贵州贵阳550004 [3]贵阳市第二人民医院影像科,贵州贵阳550081

出　　处：《贵州医科大学学报》2023年第12期1495-1500,共6页Journal of Guizhou Medical University

基　　金：国家自然科学基金(81960315);贵州医科大学学术新苗基金(黔科合平台人才〔2018〕5779-36);贵州省科技厅计划项目(筑科合同〔2019〕9129);贵州省科技计划项目(黔科合支撑〔2021〕一般099)。

摘　　要：目的探讨左室质量指数(LVMI)联合N端脑钠肽前体(NT-proBNP)、超敏肌钙蛋白(hs-cTn)对不同病因心功能不全患者的诊断价值。方法选取87例心衰患者作为心衰组,另取选取70例同期体检健康者为对照组;根据心功能分级(NYHA)将心衰组分为Ⅰ~Ⅱ级组(n=31)、Ⅲ级(n=29)组和Ⅳ级组(n=27);再根据病因再分为扩张性心肌病组(n=19)、缺血性心肌病组(n=20)、高血压性心脏病组(n=26)及心肌炎组(n=22);所有患者在入院后的次日清晨空腹抽取外周静脉血3 mL,采用全自动生化仪检测各组生化指标,包括NT-proBNP、hs-cTn、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB),同时测量所有受试者左室舒张末期容积(LVEDV)、左室短轴末期内径(LVDd)、左房内径(LAD)、室间隔厚度(IVSTd)及左室后壁厚度(LVPWT);计算LVMI,并绘制LVMI、NT-proBNP、hs-cTn单独指标及联合指标的受试者工作特征曲线(ROC),计算曲线下面积(AUC)评估各指标对心功能不全的诊断效能。结果心衰组患者LVMI、NT-proBNP、hs-cTn明显高于对照组,且随着纽约心功能(NYHA)分级的增高水平逐渐增高,差异有统计学意义(P<0.05);NYHA分级Ⅳ级组的CK水平高于对照组及NYHA分级Ⅰ~Ⅲ级组CK水平比较值,差异有统计学意义(P<0.05);在NYHA分级Ⅲ-Ⅳ级患者中,心肌炎组和缺血性心肌病组LVMI水平均低于高血压性心脏病组(P<0.05);高血压性心脏病组,单个指标中以LVMI的诊断效能最好,AUC值为0.83;缺血性心脏病组、扩张性心肌病组、心肌炎组以NT-proBNP的诊断效能最好,AUC值为0.82;高血压性心脏病组、缺血性心脏病组、扩张性心肌病组、心肌炎组,联合指标均以LVMI、NT-proBNP、hs-cTn 3项联合对不同病因造成的心衰的诊断价值最佳。结论LVMI、NT-proBNP、hs-cTn均是诊断心功能不全的有效指标,联合血生化指标时可提高临床对不同病因心功能不全患者诊断价值。Objective To explore the diagnostic value of the left ventricular mass index(LVMI)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)and hypersensitive troponin(hs-cTn)in patients with different etiologies of cardiac dysfunction.Methods A total of 87 patients with heart failure were selected as the heart failure group,and 70 healthy individuals undergoing physical examination in the same period served as the control group.The heart failure group was further divided based on the New York Heart Association(NYHA)classification into ClassⅠ-Ⅱ(n=31),ClassⅢ(n=29),and ClassⅣ(n=27).Additionally,they were categorized according to etiology:dilated cardiomyopathy(n=19),ischemic cardiomyopathy(n=20),hypertensive heart disease(n=26),and myocarditis(n=22).All patients had peripheral venous blood drawn on the morning after admission(fasting)for biochemical marker analysis using an automated biochemistry analyzer,including NT-proBNP,hs-cTn,creatine kinase(CK),and creatine kinase-MB(CK-MB).Measurements of left ventricular end-diastolic volume(LVEDV),left ventricular end-diastolic diameter(LVDd),left atrial diameter(LAD),interventricular septal thickness(IVSTd),and left ventricular posterior wall thickness(LVPWT)were also taken.LVMI was calculated and Receiver Operating Characteristic(ROC)curves for LVMI,NT-proBNP,hs-cTn alone and in combination were plotted to assess their diagnostic efficiency for heart failure.Results The LVMI,NT-proBNP,and hs-cTn levels were significantly higher in the heart failure group compared to the control group and increased with higher NYHA classification(P<0.05).CK levels in ClassⅣwere higher than in the control and ClassⅠ-Ⅲgroups(P<0.05).With increasing heart failure classification,LVMI levels were significantly higher in the hypertensive heart disease group compared to myocarditis and ischemic cardiomyopathy groups(P<0.05).In hypertensive heart disease,LVMI alone had the best diagnostic efficiency(AUC=0.83).For ischemic cardiomyopathy,dilated cardiomyopathy,and myocarditis

关 键 词：不同病因 心功能不全 LVMI 心功能生化指标 ROC曲线 

分 类 号：R445.2[医药卫生—影像医学与核医学]