估计血浆容量状态和左心房内径对急性心力衰竭患者预后的预测价值  

Prognostic value of plasma volume status and left atrial diameter in patients with acute heart failure

作　　者：张裕 姚欢 毛玲珠 沈海军 ZHANG Yu;YAO Huan;MAO Lingzhu;SHEN Haijun(Department of Cardiology,Zhangjiagang Third People's Hospital,Zhangjiagang Jiangsu 215600,China)

机构地区：[1]张家港市第三人民医院心内科,江苏张家港215600

出　　处：《中国急救复苏与灾害医学杂志》2024年第11期1409-1412,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2021年度江苏省老年科研项目(编号:LK2021041)。

摘　　要：目的 分析估计血浆容量状态(ePVs)和左心房内径(LAD)对急性心力衰竭患者预后的预测价值。方法 回顾性分析2018年10月—2023年9月期间张家港市第三人民医院收治的150例急性心力衰竭患者的临床资料,根据出院后3个月内是否发生主要心血管不良事件(MACE)分为MACE组和非MACE组。比较两组患者人口资料、实验室指标、ePVs和LAD,采用二元Logisitc回归分析急性心力衰竭患者出院后3个月内发生MACE的危险因素。采用受试者工作特征(ROC)曲线分析ePVs和LAD预测急性心力衰竭患者预后的效能。结果 随访期间有43例患者发生MACE,发生率为28.67%。单因素分析结果显示,MACE组患者体质量指数和血清白蛋白(Alb)水平显著低于非MACE组,血清氨基末端脑钠肽前体(NT-proBNP)水平和ePVs、LAD显著大于非MACE组(P<0.05)。多因素Logistic回归分析显示,血清NT-proBNP水平、ePVs和LAD是影响患者发生MACE的独立危险因素(P<0.05)。ROC曲线结果显示,ePVs预测急性心力衰竭患者发生MACE的曲线下面积(AUC)为0.834(95%CI:0.764~0.905),最佳截断值为4.73 mL/g,敏感度和特异度分别为79.07%和78.50%;LAD预测急性心力衰竭患者发生MACE的AUC为0.722(95%CI:0.643~0.802),最佳截断值为36.89 mm,敏感度和特异度分别为88.37%和42.99%。结论 ePVs和LAD对急性心力衰竭患者3个月内MACE发生有一定的预测价值,ePVs预测效能更佳。Objective To evaluate the predictive value of estimated plasma volume status(ePVs) and left atrial diameter(LAD) in patients with acute heart failure.Methods Clinical data of 150 patients with acute heart failure admitted to our hospital from October 2018 to September 2023 were retrospectively analyzed,and they were divided into MACE group and non-MACE group according to whether major cardiovascular events(MACE) occurred within 3 months after discharge.Demographic data,laboratory indicators,ePVs and LAD were compared between the two groups.Binary Logisitc regression analysis was used to establish a prediction model for MACE in patients with acute heart failure within3 months after discharge.Demographic data,laboratory indicators,ePVs and LAD were compared between the two groups.Bivariate Logisitc regression was used to analyze the risk factors for MACE in patients with acute heart failure within 3 months after discharge.Results During the follow-up period,43 patients developed MACE(28.67%).Single factor analysis results showed that the body mass index and serum Alb level in the death group were significantly lower than those in the non-MACE group,and the serum NT-proBNP level,ePVs and LAD were significantly higher than those in the non-MACE group(P<0.05).Multivariate Logistic regression analysis showed that serum NT proBNP levels,ePVs,and LAD were independent risk factors affecting the occurrence of MACE in patients(P<0.05).ROC curve results showed that the area under the curve(AUC) of ePVs predicting MACE in patients with acute heart failure was 0.834(95% CI:0.764-0.905),the optimal tangent point was 4.73 mL/g,and sensitivity and specificity of 79.07% and 78.50%.The AUC of LAD was 0.722(95% CI:0.643-0.802),the optimal tangent point was 36.89 mm,and the sensitivity and specificity were 88.37% and 42.99%,respectively.Conclusione PVs and LAD can predict the occurrence of MACE within 3 months in patients with acute heart failure,and ePVs is more effective in predicting MACE.

关 键 词：急性心力衰竭 血浆容量状态 左心房内径 主要心血管事件 预后 

分 类 号：R541.6[医药卫生—心血管疾病]