心脏超声参数积分系统对左心室收缩功能减低患者再住院风险预测价值分析

Predictive value of echocardiography parameter scoring system for re-admission risk in patients with heart failure of left ventricular systolic dysfunction

目的分析心脏超声参数积分系统应用于左心室收缩功能减低(LVSD)患者对其治疗后再入院风险的评估效果,旨在为LVSD患者预后复发情况的评估提供参考。方法选取2017-01-01-2019-12-01获嘉县中医院收治的LVSD心衰患者120例为研究对象;查阅患者病历资料,记录研究对象左心室内径、二尖瓣反流(反流束面积/左心房面积)、三尖瓣反流(反流束面积/左心房面积)、左心室射血分数(LVEF)、肺动脉收缩压、有无胸腔积液信息(具体检查项目通过超声心动图获得)。所有患者随访1年,记录其再入院情况、再入院时间;患者的一般资料进行单因素分析,差异有统计学意义的检查项目进行logistic多因素回归分析并绘制ROC曲线,探究超声参数积分系统对LVSD心衰患者再入院风险的预测价值。结果120例患者中,1年内再入院59例。单因素分析结果显示,反流束面积/左心房面积≤20%或>20%的二尖瓣反流组患者1年内再入院病例分别有44例(46.32%)和15例(60.00%),差异有统计学意义,χ^(2)=5.058,P=0.025;反流束面积/左心房面积≤20%或>20%的三尖瓣反流组患者1年内再入院病例分别有27例(39.13%)和32例(62.75%),差异有统计学意义,χ^(2)=6.543,P=0.011;有/无胸腔积液患者组患者1年内再入院病例分别有27例(39.13%)和32例(62.75%),差异有统计学意义,χ^(2)=6.543,P=0.011。logistic多因素回归分析结果显示,二尖瓣反流束面积/左心房面积>20%、三尖瓣反流束面积/左心房面积>20%、存在胸腔积液是LVSD心衰患者1年内再入院的独立危险因素,P值分别为0.007、0.022和0.008。ROC曲线分析结果显示,二尖瓣反流、三尖瓣反流情况以及心脏超声参数积分系统预测患者1年内入院风险的AUC分别为0.770、0.664和0.860。上述指标对于LVSD心衰患者再入院的风险具有良好的评估价值,其中积分系统评估效果显著优于单项指标评估。结论心脏超声参数积分系统检测二尖瓣反流情况、三尖瓣反流情况、是否存在胸腔积液对LVSD心衰患者再住院风险具有良好的预测价值,能够为患者出院后的再入院情况提供一定的参考。

Objective To analyze the effect of cardiac ultrasound parameter scoring system on the risk of readmission in patients with left ventricular systolic dysfunction(LVSD)after treatment,so as to play a certain reference value for the assessment of prognosis and recurrence in patients with LVSD.Methods From January 1,2017 to December 1,2019,120 LVSD patients with heart failure admitted to Traditional Chinese Medicine in HuoJia County were selected.Medical records of all the patients were refered.The left ventricular inner diameter,mitral valve regurgitation(reflux beam area/left atrium area),tricuspid regurgitation(reflux beam area/left atrium area),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure,the presence of pleural effusion information(specific check project acquired from echocardiography)were recorded.All subjects were followed up for 1 year,and their readmission status and time were recorded.,The general data of patients were analyzed by univariate analysis,and the examination items with statistically significant differences were analyzed by logistic multivariate regression analysis and ROC curve was drawn to explore the predictive value of ultrasound parameter scoring system for readmission risk in patients with LVSD heart failure.Results Among the 120 patients,59 cases were readmitted in 1 year.The results of univariate analysis showed that 44 and 15 cases were readmitted within one year in mitral regurgitation group with regurgitation tract area≤20%or left atrial area>20%,accounting for 46.32%and 60.00%,respectively,and the difference was statistical significant(χ^(2)=5.058;P=0.025);In the tricuspid regurgitation group with regurgitation tract area/left atrial area≤20%or>20%,there were 27cases and 32cases of readmission within one year,accounting for 39.13%and 62.75%,respectively,with statistical difference(χ^(2)=6.543;P=0.011);There were 27and 32cases of readmission within one year in patients with/without pleural effusion group,accounting for 39.13%and 62.75%,respectively,with statistical difference(χ^(2)=6.543;P=0.011).The results of Logistic multivariate regression analysis showed that mitral regurgitation bundle area/left atrial area>20%,tricuspid regurgitation bundle area/left atrial area>20%and pleural effusion were independent risk factors of re-admission within 1year(P=0.007,0.022,0.008).The results of ROC curve analysis showed that AUC values of mitral regurgitation,tricuspid regurgitation and echocardiography parameter scoring system for predicting re-admission risk were 0.770,0.664and 0.860,respectively.There was good evaluation value of the above indexes for re-admission risk,and the evaluation effect of the scoring system was significantly better than that of single index.Conclusions Cardiac ultrasound parameter integration system can be used to detect mitral regurgitation,tricuspid regurgitation and pleural effusion and have good predictive value for the risk of readmission in patients with LVSD heart failure,which can provide certain reference for the readmission of patients after discharge.