经胸壁超声心动图联合B型尿钠肽原水平检测对全身性感染患者心功能的评估

Evaluation of cardiac function of patients with systemic infection by transthoracic echocardiography combined with B type natriuretic peptide level

目的:探讨不同心功能分级的全身性感染患者B型尿钠肽原(BNP)水平,并利用经胸壁超声心动图检测患者心室结构、血流动力学及心脏功能,阐明全身性感染患者心力衰竭(心衰)的变化特点。方法:回顾性分析114例全身性感染患者的临床资料,根据是否发生心衰分为心衰组(n=35)和非心衰组(n=79),检测所有患者血浆BNP水平;利用经胸壁超声心动图检测患者左室舒张末内径(LVIDD)和左室射血分数(LVEF)值;采用Killip分级法对所有患者进行心功能分级,并与血浆BNP水平和LVEF值进行相关性分析;分析采用BNP水平检测、经胸壁超声心动图检查和BNP水平检测联合经胸壁超声心动图检查诊断全身性感染并发心衰的灵敏度和特异度。结果:心衰组患者血浆BNP水平和LVIDD值均明显高于非心衰组(t=8.985,P=0.039;t=11.459,P=0.028),LVEF值明显低于非心衰组(t=9.852,P=0.031);全身性感染患者心功能Killip分级与血浆BNP水平呈明显正相关关系(r=0.90,P<0.05),与LVEF值呈明显负相关关系(r=-0.785,P<0.05);BNP检测联合经胸壁超声心动图检查诊断全身性感染并发心衰的灵敏度和特异度均高于单独BNP水平检测联和经胸壁超声心动图检查(P<0.05)。结论:经胸壁超声心动图联合BNP水平检测可明显提高诊断全身性感染并发心衰的灵敏度和特异度。

Objective：To investigate the levels of B type natriuretic peptide fibrinogen（BNP）of the systemic infection patients with different cardiac function classifications,and to detect the ventricular structure and the hemodynamics and cardiac function of the patients by transthoracic echocardiography,and to clarify the characteristics of the cardiac function of patients with systemic infection.Methods：The clinical data of 114 patients with systemic infection were collected and analyzed retrospectively.All the patients were divided into heart failure group（n=35）and non-heart failure group（n=79）according to whether or not heart failure occured.The levels of plasma BNP were detected in all the patients,and the values of left ventricular end diastolic diameter（LVIDD）and left ventricular ejection fraction（LVEF）were detected by transthoracic echocardiography.The cardiac function classifications of all the patients were confirmed by the Killip classification method.The correlations between the cardiac function classifications and the levels of plasma BNP and the values of LVEF were analyzed.The diagnostic sensitivity and specificity of the patients with systemic infection complicated with heart failure were analyzed by BNP level detection,transthoracic echocardiography, and BNP level detection combined with transthoracic echocardiography,respectively.Results：Compared with non-heart failure group,the plasma BNP levels and LVIDD values of the patients in heart failure group were obviously increased（t=8.985,P=0.039;t=11.459,P=0.028）,but the LVEF values were obviously decreased（t=9.852,P=0.031）.The Killip classification of cardiac function had positive relationship with the plasma BNP levels in the patients with systemic infection（r=0.90,P〈0.05）;the Killip classification of cardiac function had negative relationship with the LVEF values in the patients with systemic infection（r=-0.785,P〈0.05）.The diagnostic sensitivity and specificity of the patients with systemic infection complicated with heart failure detected by BNP detection combined with transthoracic echocardiography were higher than those detected by other two detection methods alone（P 0.05）.Conclusion：The diagnostic sensitivity and specificity of patients with systemic infection complicated with heart failure can be obviously improved by BNP detection combined with transthoracic echocardiography.