超声心动图对CHD患者中重度狭窄的诊断价值及与心功能分级相关性研究  

Diagnostic value of echocardiography for moderate-severe stenosis in CHD patients and its correlation with cardiac function class

作　　者：徐萍萍 唐琪 张子宁[1] 郭强 杨小峰 XU Ping-ping;TANG Qi;ZHANG Zi-ning;GUO Qiang;YANG Xiao-feng(Department of Ultrasound Medicine,Jiangyin Hospital of Traditional Chinese Medicine,Wuxi,Jiangsu,214400,China)

机构地区：[1]江阴市中医院超声医学科,江苏无锡214400

出　　处：《心血管康复医学杂志》2024年第3期313-318,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探究超声心动图指标对冠心病(CHD)患者中重度狭窄的诊断价值及其与心功能分级相关性。方法:选择2020年12月至2022年12月期间本院收治的90例CHD患者纳入CHD组;根据NYHA分级将CHD组患者分为Ⅰ~Ⅱ级组(n=38),Ⅲ~Ⅳ级组(n=52)。根据Gensini评分分为轻度组(n=35)和中重度组(n=55)。另外选择同期于本院体检的90例健康体检者作为对照组。采用彩色超声诊断仪检测两组LVEF、LVEDd和LVESd。对比对照组和CHD组、不同心功能分级和不同冠脉狭窄程度组心功能指标;采用ROC曲线分析上述心功能指标对CHD中重度狭窄的诊断价值;采用Spearman相关分析法分析CHD患者LVEF、LVEDd、LVESd、不同狭窄程度与NYHA分级的相关性。结果:与对照组相比,CHD组LVEF显著降低,LVEDd和LVESd显著升高,P均=0.001;与轻度组相比,中重度组LVEF[(45.31±5.08)%比(40.34±3.01)%]显著降低,LVEDd[(53.92±5.09)mm比(61.68±4.79)mm]和LVESd[(52.72±4.72)mm比(58.06±3.50)mm]显著升高,P均=0.001;与Ⅰ~Ⅱ级组相比,Ⅲ~Ⅳ级组LVEF[(45.07±4.95)%比(40.23±3.06)%]显著降低,LVEDd[(54.50±5.30)mm比(61.71±4.91)mm]和LVESd[(52.92±4.63)mm比(58.22±3.43)mm]显著更高,P均=0.001。LVEF、LVEDd和LVESd联合诊断CHD中重度狭窄的AUC为0.909,显著高于三种参数单独检测的(0.733、0.787、0.789),(Z=2.925、2.125、2.043,P<0.05或<0.01)。Spearman相关性分析结果显示,LVEF与CHD患者NYHA分级呈显著负相关(r=-0.514),LVEDd和LVESd与其呈显著正相关(r=0.538、0.546,P均=0.001),CHD不同冠脉狭窄程度与NYHA分级呈显著正相关(r=0.875,P=0.001)。结论:LVEF、LVEDd和LVESd联合检测对CHD患者中重度狭窄具有较高的临床诊断价值,与其心功能分级显著相关,可作为临床CHD患者冠脉狭窄程度的评估方法之一。Objective:To explore diagnostic value of echocardiography indexes for moderate-severe stenosis in CHD patients and their correlation with cardiac function class.Methods:A total of 90 CHD patients admitted to our hospital from Dec 2020 to Dec 2022 were selected as CHD group.According to NYHA classification,CHD group was divided into class I~II group(n=38)and classⅢ~Ⅳgroup(n=52).The patients were divided into mild group(n=35)and moderate-severe group(n=55)according to Gensini score.In addition,90 healthy people who simultaneously received physical examination in our hospital were enrolled as control group.LVEF,LVEDd and LVESd were measured in two groups by color ultrasound diagnostic instrument.Cardiac function indexes were compared between control group and CHD group,mild group and moderate-severe group,class I~II group and class III~IV group.ROC curve was used to analyze the diagnostic value of above cardiac function indexes for moderate-severe stenosis in CHD patients.The correlation among LVEF,LVEDd,LVESd,different stenosis degree and NYHA class in CHD patients was analyzed by Spearman correlation analysis.Results:Compared with the control group,there was significant reduction in LVEF,and significant rise in LVEDd and LVESd in CHD group,P=0.001 all;compared with the mild group,there was significant reduction in LVEF[(45.31±5.08)%vs.(40.34±3.01)%],and significant rise in LVEDd[(53.92±5.09)mm vs.(61.68±4.79)mm]and LVESd[(52.72±4.72)mm vs.(58.06±3.50)mm]in moderate-severe group,P=0.001 all;compared with the class I~II group,there was significant reduction in LVEF[(45.07±4.95)%vs.(40.23±3.06)%],and significant rise in LVEDd[(54.50±5.30)mm vs.(61.71±4.91)mm]and LVESd[(52.92±4.63)mm vs.(58.22±3.43)mm]in classⅢ~Ⅳgroup,P=0.001 all.AUC of combined detection of LVEF,LVEDd and LVESd diagnosing moderate-severe stenosis in CHD was 0.909,which was significantly higher than those of single detections(0.733,0.787,0.789)(Z=2.925,2.125,2.043,P<0.05 or<0.01).Spearman correlation analysis showed a significant n

关 键 词：冠心病 超声心动描记术 多普勒 彩色 冠状动脉狭窄 NYHA心功能分级 

分 类 号：R541.4[医药卫生—心血管疾病]