多种临床指标联合应用在射血分数降低型和保留型急性心力衰竭鉴别诊断中的价值

The value of combination of several clinic indicators in the differential diagnose of acute heart failure with reduced ejection fraction and preserved ejection fraction

目的探讨就诊时年龄、血压、心率、氨基末端脑钠肽前体(NT-pro BNP)等指标的联合应用在鉴别诊断射血分数(EF)降低型急性心力衰竭(AHFREF)和EF保留型急性心力衰竭(AHFPEF)中的价值。方法回顾性分析急性心力衰竭(AHF)患者就诊时年龄、性别、血压、心率、NT-pro BNP、微机血糖及1 d内心脏超声等指标。将AHF患者分为AHFREF组(EF<0.5)和AHFPEF组(EF≥0.5)。用二分类Logistic回归分析建立回归方程。根据接受者工作特征(ROC)曲线选择最适诊断截点。结果入选患者130例,年龄[M(P25,P75)]74.0(64.0,80.0)岁,男79例(60.8%),女51例(39.2%)。AHFREF组50例(38.5%),AHFPEF组80例(61.5%)。X1(NT-pro BNP)、X2(收缩压)、X3(舒张压)、X4(年龄)、X5(心率)进入回归方程P=1/[1+e-(-1.432+0.524X1-0.023X2+0.038X3-0.029X4+0.012X5)],最适诊断截点0.345,准确度为76.9%,灵敏度为84.0%,特异度为72.5%。结论联合应用就诊时年龄、血压、心率、NT-pro BNP对鉴别诊断AHFREF和AHFPEF有重要的参考价值。

Objective To study the value of combination of several clinic indicators [age, blood pressure（BP）, heart rate（HR）, N terminal pro brain natriuretic peptide（NT-pro BNP）] in the differential diagnose of acute heart failure（AHF） with reduced ejection fraction（EF） and preserved ejection fraction（AHFREF, AHFPEF）. Methods Age, BP, HR, NTpro BNP, blood glucose at admission, and cardiac ultrasonic inspection indicators in 24 hours after admission of patients with AHF were analyzed retrospectively. Patients with AHF were divided into AHFREF group（EF 50%） and AHFPEF group（EF ≥50%）. The regression equation was created by binary logistic regression analysis. The optimal truncation point was selected by the receiver operator characteristic curve（ROC）. Results 130 patients with AHF were enrolled, age M（P25,P75）74.0（64.0,80.0）years old, men 79（60.8%）, women 51（43.8%）. AHFREF group（n=50,38.5%）, AHFPEF group（n=80,61.5%）. X1（NT-pro BNP）, X2（systolic blood pressure, SBP）, X3（diastolic blood pressure, DBP）, X4（age）and X5（HR）were elected into the regression equation P =1 / [1 ＋e^-（-1.432 ＋0.524X1-0.023X2 ＋0.038X3-0.029X4 ＋0.012X5）]. The optimal truncation point was0.345, with accuracy 76.9%, sensitivity 84.0%, and specificity 72.5%. Conclusion There is significant reference value of combination of age, BP, HR with NT-pro BNP at admission in the differential diagnose of AHFREF and AHFPEF.