目的 探讨经胸超声慧星尾征在心力衰竭患者心功能评价中的应用。方法 选取因急性呼吸困难入院患者187例，分为急性左心衰竭(acute left heart failure， ALHF)组和非急性左心衰竭(non-acute left heart failure， NALHF)组。对比分析两组患者肺部超声彗星尾征(ULCs)数目，超声心动图测量LAD、LVEDD、E/Ea 值和EF 值，并绘制ROC曲线，计算曲线下面积并寻找最佳诊断分界点。结果 ALHF组患者 ULCs 数目、左心房内径(LAD)、左室舒张末内径(LVEDD)、E/Ea 值均显著高于NALHF组，而EF值显著低于NALHF组，其差异有统计学意义(P<0.05)。ROC曲线下面积为0.946(95％CI 0.921～0.971)，当彗尾数>5条时，诊断心源性呼吸困难的特异性为79.6%(95％CI 66.5％～92.8％)，敏感性为92.7%(95％CI 79.2%～95.3%)，阳性预测值为90.67%(95％CI 68.29%～96.17%)，阴性预测值为79.3%(95％CI 65.1%～86.9%)，诊断准确率为82.9％(155／187)。结论 经胸超声慧星尾征能够简单、准确地评估心功能状态，临床上可列入急性呼吸困难的常规筛查。
Abstract
Objective To analyze the ultrasound lung comets (ULCs) in patients with cardiac inadequacy and evaluate its clinical value. Methods 167 patients with acute dyspnea were recruited randomly, and divided into acute left heart failure group (ALHF) and non-ALHF group (NALHF). Both groups were studied by lung ultrosonography to count ultrasound lung comets (ULCs). Left atrial diameter (LAD), left ventricular diastolic diameter end (LVEDD), the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/Ea) and left ventricular ejection fraction (EF) were measured by transthoracic echocardiography examination. The ROC curve was drawn to find the maximum Younden index as the optimal diagnosis boundary point and calculated the area under the curve. Results The median of ULCs, LAD, LVEDD and E/Ea in group ALHF were significantly higher than that in group NALHF(P<0.05). However, the median of EF in group ALHF was significantly lower than that in group NALHF(P<0.05). The area under the ROC was 0.946 (P<0.01). When B-lines>5, the sensitivity and specificity of ultrasound comet-tail sign was 92.7% (95% CI 79.2%-95.3%), and 79.6% (95% CI 66.5%-92.8%), respectively. And the positive and negative predictive values were 90.67% (95% CI 68.29%-96.17%), and 79.3% (95% CI 65.1%-86.9%), respectively for the diagnosing heart failure related acute dyspnea. The accuracy was 82.9% (155/187). Conclusions Transthoracic ultrasound comet-tail sign is a simple and accurate tool for the assessment of cardiac function which can be included in routine screening for patients with acute dyspnea.
关键词
心力衰竭 /
超声检查 /
经胸超声慧星尾征 /
急性呼吸困难
Key words
cardiac function /
ultrasonography /
transthoracic ultrasound /
comet-tail sign /
acute dyspnea
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