血浆氨基末端脑钠肽前体联合二维超声对二尖瓣反流术后患者左心室收缩功能改变的预测价值  

Predictive Value of Plasma N-terminal Brain Natriuretic Peptide Combined with Two-Dimensional Ultrasound on Left Ventricular Systolic Function in Pa⁃tients after Mitral Regurgitation

作　　者：解晓薇 步建丽 郄占军 XIE Xiaowei;BU Jianli;QIE Zhanjun(Echocardiography Room,Cardio-Cerebrovascular Hospital,General Hospital of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]宁夏医科大学总医院心脑血管病医院超声心动图室,银川750001

出　　处：《岭南心血管病杂志》2024年第1期14-21,共8页South China Journal of Cardiovascular Diseases

摘　　要：目的 探讨血浆氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)联合二维超声对二尖瓣反流(mitral regurgitation,MR)术后左心室收缩功能改变的预测价值。方法 选取2016年7月至2021年7月于宁医大总院心脑血管病医院诊治的MR患者205名纳入MR组。依据术后14 d左心室射血分数(left ventricular ejection fraction,LVEF)变化情况,将205例MR组患者分为MR1组(119例,术后LVEF未降低或降低<10%)、MR2组(86例,术后LVEF降低≥10%)。选取同期205例体检健康者作为对照组。比较3组研究对象的一般临床资料、NT-proBNP浓度及常规超声指标、二维应变超声资料。使用Logistic回归分析筛选影响MR患者术后发生LVEF降低的独立危险因素。构建预测MR患者术后发生LVEF降低的列线图模型。使用受试者工作特征曲线(receiver operating characteristic curve,ROC)比较分析NT-proBNP、整体纵向应变(global longitudinal systolic strain,GLS)、基底段收缩期纵向峰值应变(basal peak longitudinal train,BLS)及其联合评价对MR术后患者左心室收缩功能改变的预测价值。结果 NT-proBNP、GLS、BLS是MR患者术后发生LVEF降低的独立危险因素(P<0.05)。校准曲线结果显示,列线图模型的预测概率与参考概率拟合度良好,Hosmer-Lemeshow检验结果比较差异无统计学意义(P>0.05)。模型的ROC-曲线下面积(area under the curve,AUC)为0.934(95%CI:0.837~0.942,P<0.001),灵敏度、特异度分别为87.11%和85.90%。决策曲线显示阈值概率在1%~90%时,有较高的净获益值。NT-proBNP+GLS+BLS和列线图模型对MR术后患者左心室收缩功能改变的预测价值相当,且均大于各研究指标单独对MR术后左心室收缩功能改变的预测价值。结论 术前GLS、BLS、NT-proBNP是中重度MR患者术后LVEF降低的独立影响因素。三者联合预测模型可有效预测中重度MR患者术后LVEF改变情况。Objectives To analyze the predictive value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)combined with two-dimensional ultrasound on left ventricular systolic function in patients with postoperative mitral regurgitation(MR).Methods Totally 205 patients with MR diagnosed and treated in Cardio-Cerebrovascular Hospital,General Hospital of Ningxia Medical University from July 2016 to July 2021 were included in MR group.The 205 patients in MR group were divided into MR1 group(n=119,LVEF did not decrease or decreased<10%)and MR2 group(n=86,LVEF decreased≥10%).Another 205 healthy subjects were selected as control group.The general clinical data,concen-tration of NT-proBNP,conventional ultrasound index and two-dimensional strain ultrasound data were compared among the three groups.Logistic regression analysis was used to screen the independent risk factors for postoperative decrease of LVEF in patients with MR.A nomogram model was constructed to predict postoperative LVEF reduction in MR patients.Receiver operating characteristic curve(ROC)was used to compare and analyze the predictive value of NT-proBNP,glob-al longitudinal strain(GLS),basal longitudinal peak strain(BLS)and their combination in predicting the changes of left ventricular systolic function in patients after MR surgery.Results NT-proBNP,GLS and BLS were independent risk factors for the decrease of LVEF in patients with MR after operation.The results of calibration curve showed that the predic-tion probability of the Nomogram model fitted well with the reference probability,and there was no significant difference in the results of Hosmer-Lemeshow test.The area under the ROC of the model was 0.934(95%CI:0.837-0.942,P<0.001),and the sensitivity and specificity were 87.11%and 85.90%,respectively.The decision curve showed that there was a higher net gain value when the threshold probability was 1%-90%.The predictive value of NT-proBNP+GLS+BLS and line chart model for the change of left ventricular systolic function in patients after MR was simi

关 键 词：二尖瓣反流 左心室收缩功能 氨基末端脑钠肽前体 二维超声 预测价值 

分 类 号：R542.51[医药卫生—心血管疾病]