改良4分区肺超声评分法对急性心衰3月死亡或重返ICUs的预测价值  

Predictive value of modified 4-zone lung ultrasonography within 3 months death or readmission in acute heart failure

作　　者：黄文彬 徐平[1] 李靓[1] 刘伟 黄奎 周媛 朱元芳[1] HUANG Wenbin;XU Ping;LI Liang;LIU Wei;HUANG Kui;ZHOU Yuan;ZHU Yuanfang(Department of Emergency,Zigong Fourth People’s Hospital,Zigong 643000,Sichuan,China)

机构地区：[1]自贡市第四人民医院急诊科,四川自贡643000

出　　处：《西部医学》2025年第3期419-424,共6页Medical Journal of West China

基　　金：2021年自贡市第四人民医院科研计划院内培育项目(202102)。

摘　　要：目的探讨入住急诊重症监护室(EICU)的急性心衰(AHF)患者其改良4分区肺超声评分法预测3月内死亡或重返重症监护室(ICUs)的临床价值。方法回顾性纳入2018年2月—2020年5月在自贡市第四人民医院EICU诊断为AHF患者71例作为研究对象。以3月内存活且未重返ICUs作为预后良好组(n=34)、3月全因死亡或重返ICUs作为预后不良组(n=37)及终点指标,计算不同肺超声评分法预测结局的校正后的比值比(OR),比较改良4分区法与传统4分区法、8分区法的曲线下面积(AUC)、净重新分类指数(NRI)、综合判别指数(IDI)区分度,并绘制校正、决策曲线评价校准度与临床实用性。结果满足研究条件的AHF患者71例,3月全因死亡或重返ICUs 37例(52.11%)。传统4分区法的AUC值为0.601,改良4分区法的AUC值为0.679,8分区法的AUC值为0.717。与传统4分区法比较,改良4分区法(NRI=0.700,P=0.002;IDI=0.088,P=0.006)及8分区法(NRI=0.719,P=0.001;IDI=0.095,P=0.008)预测能力均正向改善。校准度以8分区法最佳,改良4分区法次之,传统4分区法最差;临床实用性改良4分区法与8分区法较佳,而传统4分区法较差。结论改良4分区法较传统4分区法对AHF患者预测3月内死亡或重返ICUs的临床价值更高。Objective To assess the value of the modified 4-zone lung ultrasonography(LUS)for predicting death or return to intensive care units(ICUs)within 3 months in patients with acute heart failure admitted to the EICU.Methods Retrospective inclusion of patients with acute heart failure diagnosed in the EICU of Zigong Fourth People's Hospital from February 7,2018 to May 22,2020 were used as the poor prognosis group and endpoint index.Death or return to ICUs within 3 months was used as the end point.To calculate adjusted odds ratios for predicting outcome by different lung ultrasound scores.Analyze the area under curve(AUC),net reclassification improvement(NRI),and integrated discrimination improvement(IDI)of the 4-zone LUS、the modified 4-zone LUS and the 8-zone LUS.The calibration and decision curves were drawn to evaluate the degree of calibration and clinical utility.Results Among the 71 patients with acute heart failure who met the study conditions,and 37(52.11%)death or return to ICUs within 3 months.The AUC value of the 4-zone LUS was 0.601,the AUC value of the modified 4-zone LUS was 0.679,and the AUC value of the 8-zone LUS was 0.717.Compared with the 4-zone LUS,the modified 4-zone LUS(NRI=0.700,P=0.002;IDI=0.088,P=0.006)and 8-zone LUS(NRI=0.719,P=0.001;IDI=0.095,P=0.008)both showed a positive improvement in predictive ability.The 8-zone LUS was the best in calibration degree,followed by the modified 4-zone LUS,and the 4-zone LUS was the worst.Clinical Practicality the modified 4-zone LUS and the 8-zone LUS were better,while the 4-zone LUS was worse.Conclusion The modified 4-zone LUS is more valuable than the 4-zone LUS in predicting death or readmission within 3 months in patients with acute heart failure.

关 键 词：急性心力衰竭 肺超声 改良4分区法 预测价值 

分 类 号：R541.6[医药卫生—心血管疾病]