经胸超声心动图评价肺动脉高压的价值  

The value of transthoracic echocardiography in evaluating pulmonary hypertension compared to right heart catheterization examination: a single center study

作　　者：张德园 崔晓霈[1] 王玉淼 张红雨[1] Zhang Deyuan;Cui Xiaopei;Wang Yumiao;Zhang Hongyu(Department of Geriatrics,Qilu Hospital,Shandong University,Jinan 250012,China;Intensive Care Unit of the Ninth People's Hospital of Zibo City,Zibo 256499,China)

机构地区：[1]山东大学齐鲁医院老年医学科,山东济南250012 [2]淄博市第九人民医院重症监护室,山东淄博256499

出　　处：《山东第一医科大学（山东省医学科学院）学报》2024年第9期550-553,共4页Journal of Shandong First Medical University ＆ Shandong Academy of Medical Sciences

基　　金：山东省自然科学基金面上项目(ZR2021MH111)。

摘　　要：目的探索经胸超声心动图(transthoracic echocardiography,TTE)检查与右心导管(right heart catheterization,RHC)检查评估肺动脉高压(pulmonary hypertension,PH)的一致性。方法回顾性分析2018年1月至2021年6月山东大学齐鲁医院经RHC检查诊断明确的PH患者249例,以RHC检查测得的肺动脉平均压(mean pulmonary artery pressure,mPAP)>20 mmHg为诊断PH标准,采用受试者工作特征(receiver operating characteristic,ROC)曲线、Kappa一致性分析、Bland-Altman一致性分析等考察TTE评估PH的准确性及与RHC检查的一致性。结果两种方法测得肺动脉收缩压(systolic pulmonary artery pressure,SPAP)、mPAP的相关性均具有统计学意义(r_(SPAP)=0.800,r_(mPAP)=0.744,P<0.001),配对样本t检验显示,两者测得的SPAP差异无统计学意义(P>0.05),两者测得的mPAP差异具有统计学意义(P<0.05)。ROC曲线判断TTE检查测得的SPAP筛查PH的可靠性,ROC曲线下面积(area under ROC curve,AUC)为0.964,最大约登指数为0.864,灵敏度为0.912,特异度为0.952,TTE检查测得的SPAP截断值为38.5 mmHg。TTE检查测得的SPAP、mPAP筛查PH与RHC检查的一致性分析Kappa值分别为0.844、0.825。Bland-Altman一致性分析可知,TTE检查与RHC检查分别测得的SPAP差值均值为0.36,95%一致性界限(limits of agreement,LoA)为-29.22~29.94,235(94.38%)个点位于95%LoA内。TTE检查与RHC检查测得的mPAP差值平均值为-2.98,95%LoA为-20.66~14.69,总体235(94.38%)个点位于95%LoA内。结论TTE检查测得的mPAP与SPAP与RHC检查测得的mPAP与SPAP相关性良好,用于筛查PH具有较高的灵敏度及特异度。Objective:To evaluate the consistency of non-invasive transthoracic echocardiography(TTE)in evaluating pulmonary hypertension(PH)and right heart catheterization.Methods:A retrospective analysis was conducted on 249 patients diagnosed with suspected pulmonary hypertension after right heart catheterization(RHC)in Qilu Hospital,Shandong University from January 2018 to June 2021.The diagnostic PH standard was mPAP>20 mmHg measured by RHC.ROC curve,Kappa consistency analysis,and Bland Altman consistency analysis were used to evaluate the accuracy of echocardiography in evaluating PH and its consistency with RHC.Results:The correlation between SPAP and mPAP measured by the two methods was statistically significant(r_(SPAP)=0.800,r_(mPAP)=0.744,P<0.001).The paired sample t-test showed that the difference in SPAP measured between the two was not statistically significant(P>0.05),while the difference in mPAP measured between the two was statistically significant(P<0.05).The ROC curve determines the reliability of SPAP screening for PH in echocardiography,with AUC=0.964,maximum Youden index=0.864,sensitivity=0.912,specificity=0.952.The ultrasound measured SPAP cutoff value was 38.5 mmHg.The Kappa values of TTE SPAP and mPAP screening for PH and RHC were 0.844 and 0.825,respectively.According to the Bland Altman consistency analysis,the detection values of TTE SPAP and RHC SPAP are Bias=0.36,with a 95%limits of agreement(LoA):−29.22~29.94,and 235(94.38%)points located within the 95%consistency limit.TTE mPAP and RHC mPAP bias=−2.98,with a 95%LoA:−20.66~14.69,and a total of 235(94.38%)points within the 95%consistency threshold.Conclusion:The correlation between mPAP and SPAP measured by TTE and RHC in our center is good,and it has high sensitivity and specificity for screening PH.

关 键 词：肺动脉高压 经胸超声心动图 右心导管检查 准确率 

分 类 号：R540.45[医药卫生—心血管疾病] R544.1[医药卫生—内科学]