床旁心肺联合超声对心源性肺水肿的诊断价值  

The diagnostic value of bedside cardiopulmonary combined ultrasonography for cardiogenic pulmonary edema

作　　者：刘广会[1] 安娜[1] 朱永涛[1] 宋彦涛 赵小琪 于俊欣[1] 丁帅 LIU Guanghui;AN Na;ZHU Yongtao;SONG Yantao;ZHAO Xiaoqi;YU Junxin;DING Shuai(Department of Ultrasound,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院超声科,100102

出　　处：《心肺血管病杂志》2024年第7期748-753,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：中国中医科学院望京医院院级课题培育项目(WJYY2020-013)。

摘　　要：目的:探讨床旁心肺联合超声对心源性肺水肿的诊断价值。方法:选取2020年12月至2022年4月,于中国中医科学院望京医院因急性呼吸困难住院的患者67例,根据诊断结果分为心源性肺水肿组(39例)和非心源性肺水肿组(28例)。所有患者住院后行肺超声检查,通过测量B线总数来计算B线评分,并用超声心动图检查测量LVEF、二尖瓣口舒张早期血流速度(E)与二尖瓣环舒张早期运动速度(E’)之比(E/E’);测定血浆中NT-proBNP的浓度。利用Pearson相关法分析B线评分与LVEF、E/E’、NT-proBNP之间的相关性。通过绘制B线评分及NT-proBNP的ROC曲线,比较曲线下面积(AUC),进而评价和比较B线评分与NT-proBNP在诊断心源性肺水肿中的敏感性、特异性和准确性。结果:心源性肺水肿患者的B线评分、E/E’值及NT-proBNP值均高于非心源性肺水肿(t=7.517,t=10.537,t=31.857;所有P<0.001),而LVEF值则相对较低(t=-30.766,P<0.001)。此外,B线评分和血清NT-proBNP、E/E’呈显著正相关(r=0.787;r=0.649;所有P<0.001),与LVEF呈负相关(r=-0.705,P<0.001)。ROC曲线分析进一步显示,以B线评分作为诊断心源性呼吸困难的指标时,其ROC曲线下的面积达到0.9595,AUC值超过0.9,显示出较高的预测价值。当B线评分>8时,其诊断心源性肺水肿的敏感度为78.9%,特异度为95%,将临界值设为8分,其诊断的敏感度、特异度、阳性预测值均较高。此外,与NT-proBNP相比,B线评分在诊断心源性呼吸困难时表现出更高的敏感性、特异性和准确性。结论:床旁心肺联合超声对心源性肺水肿诊断准确率较高,且灵活便捷,值得临床推广;将B线评分临界值设为8分,其诊断的敏感度、特异度、阳性预测值均较高。Objective:To explore the diagnostic value of bedside cardiopulmonary combined ultrasound for cardiogenic pulmonary edema.Methods:A totle of 67 patients hospitalized at Wangjing Hospital of the Chinese Academy of Traditional Chinese Medicine due to acute respiratory difficulties from December 2020 to April 2022 were selected.They were divided into 39 cases of cardiogenic pulmonary edema and 28 cases of non-cardiogenic pulmonary edema based on the diagnosis.All patients underwent pulmonary ultrasound examination after admission,and the total number of B-lines was measured to calculate the B-line score.Echocardiography was performed to measure LVEF,the ratio of early diastolic blood flow velocity(E)to early diastolic motion velocity(E')of the mitral annulus(E/E')and plasma NT proBNP concentration.Independent sample t-tests were used to compare the differences between the two groups and Pearson correlation analysis was used to analyze the correlation between the total number of B-lines and LVEF,E/E',NT proBNP.ROC curve were plotted for B-line score and NT-proBNP,and the area under the curve(AUC)was compared to evaluate and compare the sensitivity,specificity,and accuracy of B-line score and NT-proBNP in diagnosing cardiogenic pulmonary edema.Results:Patients with cardiogenic pulmonary edema had higher B-line scores,E/E'values,and NT-proBNP values than those with non-cardiogenic pulmonary edema(t=7.517;t=10.537;t=31.857,all P<0.001),while the LVEF value was relatively lower(t=-30.766,P<0.001).Additionally,The B-line score was positively correlated with serum NT proBNP,E/E'(r=0.787;r=0.649,all P<0.001),and negatively correlated with LVEF(r=-0.705,P<0.001).Further ROC curve analysis showed that when using the B-line score as a diagnostic indicator for cardiogenic respiratory distress,the area under the ROC curve reached 0.9595,with an AUC value exceeding 0.9,indicating high predictive value.When B-line score was greater than 8,the sensitivity for diagnosing cardiogenic pulmonary edema was 78.9%,and the specificity was 9

关 键 词：肺部超声B线 心源性肺水肿 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]