Tei指数、右心室面积变化分数、右房室瓣环收缩期位移、肺动脉收缩压对慢性肺源性心脏病的诊断价值及其与血浆N末端B型利钠肽前体水平的相关性研究

摘要

目的 探讨Tei指数、右心室面积变化分数(FAC)、右房室瓣环收缩期位移(TAPSE)、肺动脉收缩压(PASP)对慢性肺源性心脏病的诊断价值及其与血浆N末端B型利钠肽前体(NT-proBNP)水平的相关性.方法 选取2013年6月—2017年1月宜兴市人民医院收治的慢性肺源性心脏病患者337例,根据心肺功能代偿情况分为代偿组(n=64)和失代偿组(n=273),并根据失代偿程度将失代偿组患者分为呼吸困难组(n=118)、右心衰竭组(n=103)、全心衰竭组(n=52);另选取同期体检健康者52例作为对照组.比较对照组、代偿组、失代偿组受试者及代偿组、呼吸困难组、右心衰竭组、全心衰竭组患者Tei指数、FAC、TAPSE、PASP及血浆NT-proBNP水平,绘制ROC曲线以评价Tei指数、FAC、TAPSE、PASP及血浆NT-proBNP水平对慢性肺源性心脏病的诊断价值;Tei指数、FAC、TAPSE、PASP与慢性肺源性心脏病患者血浆NT-proBNP水平的相关性分析采用Pearson相关分析.结果(1)代偿组、失代偿组患者Tei指数、PASP及血浆NT-proBNP水平高于对照组,FAC低于对照组,TAPSE小于对照组(P<0.05);失代偿组患者Tei指数、PASP及血浆NT-proBNP水平高于代偿组,FAC低于代偿组,TAPSE小于代偿组(P<0.05).(2)呼吸困难组、右心衰竭组、全心衰竭组患者Tei指数、PASP及血浆NT-proBNP水平高于代偿组,FAC低于代偿组,TAPSE小于代偿组(P<0.05);右心衰竭组、全心衰竭组患者Tei指数、PASP及血浆NT-proBNP水平高于呼吸困难组,FAC低于呼吸困难组,TAPSE小于呼吸困难组(P<0.05);全心衰竭组患者Tei指数、PASP及血浆NT-proBNP水平高于右心衰竭组,FAC低于右心衰竭组,TAPSE小于右心衰竭组(P<0.05).(3)绘制ROC曲线发现,Tei指数、FAC、TAPSE、PASP及血清NT-proBNP水平诊断慢性肺源性心脏病的曲线下面积(AUC)分别为0.654〔95％CI(0.557,0.751)〕、0.960〔95％CI(0.929,0.990)〕、0.821〔95％CI(0.742,0.899)〕、0.854〔95％CI(0.799,0.929)〕、0.906〔95％CI(0.853,0.960)〕;FAC、PASP、血浆NT-proBNP水平诊断慢性肺源性心脏病的AUC大于Tei指数、TAPSE(P<0.05).(4)Pearson相关分析结果显示,FAC(r=-0.527)、TAPSE(r=-0.361)与慢性肺源性心脏病患者血浆NT-proBNP水平呈负相关,而PASP(r=0.428)与慢性肺源性心脏病患者血浆NT-proBNP水平呈正相关(P<0.05).结论 Tei指数、FAC、TAPSE、PASP及血浆NT-proBNP水平对慢性肺源性心脏病均有一定诊断价值,其中FAC、PASP及血浆NT-proBNP水平的诊断价值较高;FAC、TAPSE与慢性肺源性心脏病患者血浆NT-proBNP水平呈负相关,而PASP与慢性肺源性心脏病患者血浆NT-proBNP水平呈正相关.%Objective To investigate the diagnostic value of Tei index,FAC,TAPSE and PASP on chronic pulmonary heart disease and their correlations with plasma NT-proBNP level.Methods A total of 337 patients with chronic pulmonary heart disease were selected in the People's Hospital of Yixing from June 2013 to January 2017,and they were divided into compensation group(n=64)and decompensation group(n=273)according to compensation status of cardiopulmonary function,then patients in decompensation group were divided into dyspnea group(n=118),right heart failure group(n=103) and whole heart failure group(n=52)according to the compensation degree;meanwhile a total of 52 healthy volunteers were selected as control group. Tei index,FAC,TAPSE,PASP and plasma NT-proBNP level were compared in control group, compensation group and decompensation group,as well as in compensation group,dyspnea group,right heart failure group and whole heart failure group,ROC curves were drawn to evaluate the diagnostic value of Tei index,FAC,TAPSE,PASP and plasma NT-proBNP level on chronic pulmonary heart disease,and Pearson correlation analysis was used to analyze the correlations of Tei index,FAC,TAPSE and PASP with plasma NT-proBNP level in patients with chronic pulmonary heart disease.Results (1)Tei index,PASP and plasma NT-proBNP level in compensation group and decompensation group were statistically significantly higher than those in control group,while FAC,TAPSE and plasma NT-proBNP level in compensation group and decompensation group were statistically significantly lower than those in control group(P<0.05);Tei index and PASP in decompensation group were statistically significantly higher than those in compensation group,while FAC and TAPSE in decompensation group were statistically significantly lower than those in compensation group(P<0.05).(2)Tei index, PASP and plasma NT-proBNP level in dyspnea group,right heart failure group and whole heart failure group were statistically significantly higher than those in compensation group,while FAC and TAPSE in dyspnea group,right heart failure group and whole heart failure group were statistically significantly lower than those in compensation group(P<0.05);Tei index,PASP and plasma NT-proBNP level in right heart failure group and whole heart failure group were statistically significantly higher than those in dyspnea group,while FAC and TAPSE in right heart failure group and whole heart failure group were statistically significantly lower than those in dyspnea group(P<0.05);Tei index,PASP and plasma NT-proBNP level in whole heart failure group were statistically significantly higher than those in right heart failure group,while FAC and TAPSE in whole heart failure group were statistically significantly lower than those in right heart failure group.(3)ROC curves showed ththat,AUC of Tei index,FAC,TAPSE,PASP and plasma NT-proBNP level in diagnosing chronic pulmonary heart disease was 0.654〔95％CI(0.557,0.751)〕,0.960〔95％CI(0.929,0.990)〕,0.821〔95％CI(0.742,0.899)〕,0.854〔95％CI(0.799, 0.929)〕 and 0.906〔95％CI(0.853,0.960)〕,respectively;AUC of FAC,PASP and plasma NT-proBNP level was statistically significantly larger than that of Tei index and TAPSE in diagnosing chronic pulmonary heart disease,respectively (P<0.05).(4)Pearson correlation analysis results showed that,FAC(r=-0.527)and TAPSE(r=-0.361)was negatively correlated with plasma NT-proBNP level in patients with chronic pulmonary heart disease,respectively,while PASP(r=0.428) was positively correlated with plasma NT-proBNP level(P<0.05).Conclusion Tei index,FAC,TAPSE,PASP and plasma NT-proBNP level have certain diagnostic value on chronic pulmonary heart disease,thereinto diagnostic value of FAC, PASP and plasma NT-proBNP level is relatively high;FAC and TAPSE is negatively correlated with plasma NT-proBNP level in patients with chronic pulmonary heart disease,respectively,while PASP is positively correlated with plasma NT-proBNP level.