肺动脉高压患者心音图特征及其诊断价值  

Phonocardiogram characteristics of patients with pulmonary artery hypertension and its diagnostic value

作　　者：王万虹 张义 张琼 WANG Wanhong;ZHANG Yi;ZHANG Qiong(Department of Cardiology,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian,Jiangsu 223800,China)

机构地区：[1]徐州医科大学附属宿迁医院(南京鼓楼医院集团宿迁医院)心内科,江苏宿迁223800

出　　处：《临床肺科杂志》2024年第6期838-841,853,共5页Journal of Clinical Pulmonary Medicine

基　　金：徐州医科大学附属医院发展基金项目(No.XYFM2020039);江苏省卫生健康委科研项目(No.Z2021085)。

摘　　要：目的 探究肺动脉高压患者心音图特征及其诊断价值。方法 回顾性分析2021年1月-2022年12月徐州医科大学附属宿迁医院收治的90例疑似肺动脉高压(PAH)的患者临床资料,探究PAH患者典型心音图特点。以右心导管为金标准,参照心脏超声,探究心音图在PAH患者中的诊断价值。结果 右心导管检查结果显示,90例患者中共30例确诊为PAH,纳入PAH组,其余60例为非PAH,纳入非PAH组;两组P2亢进、S2分裂、S1分裂、舒张晚期奔马律比较差异有统计学意义(P均<0.05)。心音图检查结果显示,90例患者中,共28例患者诊断为PAH,另62例为非PAH。以右心导管为金标准,心音图诊断PAH的敏感度为76.67%、特异度为91.67%、准确率为86.67%、阳性预测值为82.14%、阴性预测值为88.71%、kappa值为0.695。心脏超声检查结果显示,90例患者中,共33例患者诊断为PAH,另57例为非PAH。以右心导管为金标准,心脏超声诊断PAH的敏感度为80.00%、特异度为85.00%、准确率为83.33%、阳性预测值为72.73%、阴性预测值为89.47%、kappa值为0.634。心音图与心脏超声联合检查结果显示,90例患者中,共40例患者诊断为PAH,另50例为非PAH。以右心导管为金标准,联合心脏超声诊断PAH的敏感度为96.67%、特异度为81.67%、准确率为86.67%、阳性预测值为72.50%、阴性预测值为98.00%、kappa值为0.723。结论 心音图在诊断PAH中具有与右心导管较好的一致性,诊断效能与心脏超声相当且与心脏超声联合诊断可提升敏感度,可用于临床推广。Objective To investigate the phonocardiogram characteristics of patients with pulmonary artery hypertension(PAH)and its diagnostic value.Methods The clinical data of 90 patients who were suspected with PAH and admitted to Suqian Hospital affiliated to Xuzhou Medical University from January 2021 to December 2022 were analyzed retrospectively.The typical phonocardiogram characteristics of patients with PAH were analyzed.Taking right heart catheterization as the gold standard and referring to cardiac ultrasound,the diagnostic value of phonocardiogram in patients with PAH was evaluated.Results The results of right heart catheterization showed that there were 30 patients with PAH and 60 patients without.There were statistically significant differences in P2 hyperactivity,S2 division,S1 division and late diastolic gallop rhythm between the two groups(P<0.05).Phonocardiography showed that there were 28 patients with PAH and 62 patients without.With right heart catheterization as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and kappa value of phonocardiography for diagnosing PAH were 76.67%,91.67%,86.67%,82.14%,88.71%and 0.695,respectively.The results of cardiac ultrasound examination showed that there were 33 patients with PAH and 57 patients without.With right heart catheterization as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and kappa value of cardiac ultrasound for diagnosing PAH were 80.00%,85.00%,83.33%,72.73%,89.47%and 0.634,respectively.The combined examination of phonocardiography and cardiac ultrasound found that there were 40 patients with PAH and 50 patients without.With right heart catheterization as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and kappa value of the combined diagnosis with phonocardiography and cardiac ultrasound were 96.67%,81.67%,86.67%,72.50%,98.00%and 0.723,respectively.Conclusion Echocardiogram is we

关 键 词：肺动脉高压 心音图 诊断 

分 类 号：R544.1[医药卫生—心血管疾病]