心脏超声结合血清指标检查构建Logistic模型评估心律失常患者心功能分级的研究  

Study of Logistic Model Constructed by Cardiac Ultrasound with Serum Index in Evaluating Cardiac Function Grading in Patients with Arrhythmia

作　　者：李勉 詹小林 黄磊[1] 张超学[1] LI Mian;ZHAN Xiaolin;HUANG Lei(The First Affiliated Hospital of Anhui Medical University,Anhui Hefei 230000,China)

机构地区：[1]安徽医科大学第一附属医院超声医学科,安徽合肥230000

出　　处：《河北医学》2025年第2期330-335,共6页Hebei Medicine

基　　金：2019年安徽省重点研究与开发计划项目,(编号:201904a07020008)。

摘　　要：目的:探究心脏超声结合血清指标检查构建Logistic模型评估心律失常(AR)患者心功能分级的研究。方法:选取2021年2月至2024年4月本院收治的105例AR患者为研究对象(AR组),根据心功能分级标准,将AR患者分为Ⅰ~Ⅱ级组(n=45例)和Ⅲ~Ⅳ级组(n=60例)。同期选取在本院健康体检的志愿者为对照组(30例)。收集AR患者的临床资料,比较AR组和对照组、Ⅰ~Ⅱ级组和Ⅲ~Ⅳ级组的血清脑钠肽(BNP)、超敏C反应蛋白(hs-CRP)水平及心脏超声参数[左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)]。采用Logistic回归分析筛选影响心功能分级的危险因素,并构建Logistic模型评估心脏超声参数及血清BNP、hs-CRP对心功能分级的诊断价值。结果:与对照组相比,AR组LVEF明显下降,AR组LVEDD和LVESD明显升高,差异均有统计学意义(P<0.05)。AR组血清BNP和hs-CRP水平较对照组明显升高(P<0.05)。单因素分析显示,Ⅰ~Ⅱ级组和Ⅲ~Ⅳ级组在LVEF、LVEDD、LVESD、血清BNP和hs-CRP方面差异具有统计学意义(P<0.05)。Logistic多因素回归分析显示,LVEF水平降低,LVEDD、LVESD、BNP、hs-CRP水平升高均是影响心功能分级的危险因素(P<0.05)。ROC曲线分析显示,心脏超声指标联合血清BNP、hs-CRP构建的Logistic模型的AUC为0.907,敏感度为88.89%,特异度为78.33%,95%CI为0.913~0.977(P<0.05)。结论:心脏超声联合血清BNP、hs-CRP构建Logistic模型对心律失常患者的心功能分级有较高的临床诊断价值,为临床评估心功能分级提供可靠依据。Objective:To explore the study of Logistic model constructed by cardiac ultrasound with serum index in evaluating cardiac function grading in patients with arrhythmia(AR).Methods:Totally 105 AR patients in the hospital from February 2021 to April 2024 were enrolled(AR group).According to the grading of cardiac function,the AR patients were divided into grade Ⅰ-Ⅱ group(n=45)and grade Ⅲ-Ⅳ group(n=60).At the same time,volunteers who received physical examination in the hospital were included in the control group(n=30).The clinical data of AR patients were collected,and the levels of serum brain natriuretic peptide(BNP),high-sensitivity C-reactive protein(hs-CRP)and cardiac ultrasound parameters(left ventricular ejection fraction[LVEF],left ventricular end-diastolic diameter[LVEDD]and left ventricular end-systolic diameter[LVESD])were compared between AR group and control group,between grade Ⅰ~Ⅱ group and grade Ⅲ-Ⅳ group.Logistic regression analysis was adopted to screen the risk factors affecting cardiac function grading,and a Logistic model was constructed to evaluate the diagnostic value of cardiac ultrasound parameters and serum BNP and hs-CRP on cardiac function grading.Results:Compared with the control group,the LVEF in the AR group was significantly decreased,while the LVEDD and LVESD were significantly increased(P<0.05).The levels of serum BNP and hs-CRP in the AR group were significantly enhanced compared with the control group(P<0.05).Univariate analysis indicated that there were statistical differences in LVEF,LVEDD,LVESD,serum BNP and hs-CRP between grade Ⅰ-Ⅱ group and grade Ⅲ~Ⅳ group(P<0.05).Logistic multivariate regression analysis demonstrated that the decrease of LVEF and increases of LVEDD,LVESD,BNP and hs-CRP were all risk factors affecting cardiac function grading(P<0.05).ROC curve analysis found that the AUC,sensitivity,specificity and 95%CI of the Logistic model constructed by cardiac ultrasound combined with serum BNP and hs-CRP were 0.907,88.89%,78.33% and 0.913-0.977,re

关 键 词：心脏超声 超敏C反应蛋白 脑钠肽 心律失常 心功能分级 LOGISTIC模型 

分 类 号：R541.7[医药卫生—心血管疾病] R445.1[医药卫生—内科学]