肺部超声对心力衰竭患者预后的评价

摘要

Objective To evaluate the prognostic value of the number of B lines (also call Ultrasound Lung Comets, ULCs) at discharge to predict rehospitalization or death for patients with heart failure (HF) in short-term. Methods Serial clinical and ultrasound assessments were performed on 136 HF patients within 24 h of admission (T1), the second day in hospital (T2) and within 24 h of discharge (T3).The assessments included NT - proBNP, left ventricular ejection fraction (LVEF) and the number of B lines. Results The mean NT-proBNP decreased from 1908.95±684.63 Pg/ml (T1) to 506.71±339.56 pg/ml(T3), and the ULCs declined from 19±5 (T1) to 9±3 (T3) simultaneously. During 3 months follow-up, 27 patients were rehospitalized for decompensated HF and 1 died for cardiac arrest. ROC curve analysis showed that ULCs ≥10 were the best cutoff point with a sensitivity of 0.714 and a specificity of 0.685. Kaplan-Meier analysis suggests event-free survival was highest in patients with less B-lines (<10) and lowest in patients with more B-lines (≥10) (log rank χ2=16.67, P<0.001). Conclusion Lung ultrasound can reflect the changes of pulmonary edema in real time, and the number of B-lines at discharge is a strong predictor of rehospitalization or death in short-term for patients with HF.%目的 评价B线(ULCs,肺彗尾征)在心力衰竭住院患者短期预后方面的预测价值.方法筛选136例心功能不全成年患者,于入院当天(T1)、住院第2 d(T2)及出院当天(T3)完善肺部超声和N末端脑钠肽前体(NT-proBNP)等检查,统计分析B线与NT-proBNP、3个月内心力衰竭再住院或全因死亡事件的关系.结果 心力衰竭患者的NT-proBNP由入院时(1908.95±684.63)pg/ml降至出院时(506.71±339.56)pg/ml,ULCs也相应地由(19±5)(T1)降至(9±3) (T3)条;ROC曲线分析示ULCs≥10条为最佳截断点,其敏感性0.714,特异性为0.685;Kaplan-Meier分析提示ULCsT3<10条组患者3个月内无事件生存率较高(Log Rank χ2=16.67,P<0.001).结论 肺超声是一种实用的监测肺水肿工具,出院时B线可有效预测心力衰竭住院患者短期心力衰竭再住院或全因死亡发生.