急性脑梗死患者心脏超声指标在疾病严重程度和预后评估中的价值  

Prediction value of cardiac ultrasound indexes in disease severity and prognosis of patients with acute cerebral infarction

作　　者：宁然 陆霞辉 张青 NING Ran;LU Xiahui;ZHANG Qing(Department of Ultrasound,Zhejiang Medical and Health Group,Hangzhou Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省医疗健康集团杭州医院超声科,310022

出　　处：《心电与循环》2025年第1期77-80,99,I0004,共6页Journal of Electrocardiology and Circulation

基　　金：杭州市医药卫生科技计划项目(B20230341)。

摘　　要：目的探讨急性脑梗死(ACI)患者心脏超声(下称心超)指标在疾病严重程度和预后评估中的价值。方法回顾性选取2021年1月至2023年3月在浙江省医疗健康集团杭州医院就诊的ACI患者146例,按照入院48 h内美国国立卫生研究院卒中量表(NIHSS)评分分为中重度ACI(>3分)组68例,轻度ACI(≤3分)组78例。按照患者出院90 d后改良Rankin量表(m RS)评分分为预后不良(>2分)组49例,预后良好(≤2分)组96例。比较轻度ACI组与中重度ACI组临床资料及心超指标[包括左心房内径(LAD)、左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、舒张末期室间隔厚度(IVSd)、舒张末期左心室后壁厚度(LVPWd)、主肺动脉内径(MPA)等],采用Pearson相关分析心超指标与NIHSS评分的相关性。比较预后良好组与预后不良组心超指标,采用ROC曲线分析心超指标对ACI患者预后的预测效能。结果与轻度ACI组比较,中重度ACI组LAD、IVSd、IVPWd和LVEDd均明显增加,LVEF明显减小,差异均有统计学意义(均P<0.01)。ACI患者LAD、IVSd、IVPWd和LVEDd与NIHSS评分均呈正相关(r=0.596、0.645、0.706、0.691,均P<0.01)。与预后不良组比较,预后良好组LAD、IVSd、IVPWd和LVEDd均明显减小,LVEF明显增加,差异均有统计学意义(均P<0.01)。LAD(AUC=0.749)、IVSd(AUC=0.777)、IVPWd(AUC=0.795)、LVEDd(AUC=0.650)、LVEF(AUC=0.752)对ACI患者预后均有一定的预测效能(均P<0.05);上述5项心超指标联合预测效能最佳,其AUC、灵敏度、特异度分别为0.919、0.857、0.927。结论心超指标LAD、IVSd、IVPWd、LVEDd和LVEF均与ACI疾病严重程度和预后有关,5项指标联合检测对患者预后的预测效能较高。Objective To explore the relationship of cardiac ultrasound indexes with disease severity and prognosis of patients with acute cerebral infarction(ACI).Methods A total of 146 patients with ACI treated in Zhejiang Medical and Health Group,Hangzhou Hospital were retrospectively enrolled between January 2021 and March 2023.According to scores of National Institutes of Health Stroke Scale(NIHSS)within 48 h after admission,they were divided into moderate-severe ACI group(>3 points,n=68)and mild ACI group(≤3 points,n=78).According to scores of modified Rankin Scale(mRS)90 d after discharge,patients were divided into poor prognosis group(>2 points,n=49)and good prognosis group(≤2 points,n=96).The clinical data and cardiac ultrasound indexes[left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),end-diastolic interventricular septal thickness(IVSd),end-diastolic left ventricular posterior wall thickness(LVPWd),and main pulmonary artery diameter(MPA)]were compared between mild and moderate-severe ACI groups.The correlation between cardiac ultrasound indexes and NIHSS score was analyzed by Pearson correlation analysis.The cardiac ultrasound indexes were compared between good and poor prognosis groups.The predictive efficiency of cardiac ultrasound indexes for prognosis of ACI patients was analyzed by ROC curves.Results Compared with mild ACI group,LAD,IVSd,IVPWd and LVEDd in moderate-severe ACI group were significantly increased,while LVEF was significantly decreased(all P<0.01).LAD,IVSd,IVPWd and LVEDd were positively correlated with NIHSS score in ACI patients(r=0.596,0.645,0.706,and 0.691,all P<0.01).Compared with poor prognosis group,LAD,IVSd,IVPWd and LVEDd in good prognosis group were significantly decreased,while LVEF was significantly increased(all P<0.01).LAD(AUC=0.749),IVSd(AUC=0.777),IVPWd(AUC=0.795),LVEDd(AUC=0.650)and LVEF(AUC=0.752)all had certain predictive efficiency for prognosis of ACI patients(all P<0.05).The prediction efficiency of combined

关 键 词：心脏超声 急性脑梗死 严重程度 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]