经胸超声心动图对老年患者左心瓣膜钙化诊断的准确性评价

Accuracy assessment of transthoracic echocardiography in diagnosing left cardiac valve calcification in elderly patients

目的评价经胸超声心动图（TTE）检查在老年患者左心瓣膜钙化诊断中的准确性。方法回顾性分析，收集1982—2015年在北京医院行心脏瓣膜病理检查的410例老年尸检患者，患者生前均行TTE检查；根据死亡的不同年代分为3组：1982-1995年组、1996-2005年组、2006～2015年组；根据死亡的不同年龄分为3组：60～75岁组、76～90岁组、91～106岁组。结果以病理检查结果为金标准，TTE检查诊断老年左心瓣膜钙化的敏感度、特异度、诊断符合率、阳性似然比、阴性似然比、阳性预测值、阴性预测值分别为88．6％、28．2％、43．7％、1．234、0．405、0．298、0．878。与1982-1995年组比较，1996-2005年组、2006～2015年组随着时代发展，TTE检查诊断老年左心瓣膜钙化的敏感度、阳性预测值逐渐升高，特异度、阳性似然比、阴性似然比、阴性预测值逐渐下降。与60～75岁组比较，76～90岁组、91～106岁组随着患者年龄增长，TTE检查诊断老年左心瓣膜钙化的敏感度、阳性预测值逐步增加，特异度、诊断符合率逐渐下降。以病理检查作为金标准，TTE检查诊断老年主动脉瓣瓣膜与二尖瓣瓣膜钙化的敏感度、特异度、诊断符合率、阳性似然比、阴性似然比、阳性预测值、阴性预测值分别为88．2％与44．0％、30．8％与75．3％、42．7％与71．5％、1．275与1．780、0．382与0．744、0．250与0．198、0．909与0．906。结论TTE检查对诊断老年左心瓣膜钙化尤其是主动脉瓣瓣膜钙化敏感度很高，不易漏诊，但特异度欠佳。

Objective To investigate the accuracy of transthoracic echocardiography （TTE） for diagnosing left cardiac valve calcification in elderly patients. Methods In this retrospective study, 410 elderly patients died in Beijing Hospital from 1982 to 2015 were collected. They all had full pathological cardiac valve examination data in the autopsy examination and full mortem TTE data. They were classified into three groups according to the year of death： group 1982-1995, group 1996-2005 and group 2006-2015,as well as into three groups according to the age of death：group 60- 75,group76-90 and group 91-106. Results The sensitivity, specificity, diagnostic coincidence rate, positive likelihood ratio （PLR）, negative likelihood ratio （ NLR）, positive predictive value （PPV） and negative predictive value（NPV） of TTE versus autopsy pathological findings as golden standard for diagnosing left cardiac valve calcification were 88.6%,28.2%, 43.7%,1.234, 0.405, 0.298 and 0.878. Compared with group 1982-1995, the group 1996-2005 and group 2006-2015 showed the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification in the elderly were increased while the specificity, PLR, NLR and NPV were decreased. Compared with group 60 75, the group 76-90 and group 91-106 showed that the sensitivity and PPV of TTE versus golden standard autopsy findings for diagnosing left cardiac valve calcification were increased, while the specificity and diagnostic coincidence rate were decreased. The sensitivity, specificity, diagnostic coincidence rate, PLR, NLR, PPV, NPV of TTE versus golden standard autopsy findings for the diagnosis of aortic valve calcification and mitral valve calcification in the elderly were 88.2% and 44.0% ,30.8% and 75.3% ,42.7% and 71.5% ,1. 276 and 1. 780,0. 382 and 0. 744,0. 250 and 0. 198,0. 909 and 0. 906,respectively. Conclusions TTE provides high sensitivity for diagnosing left cardiac valve calcification in the elderly,especially for diagnosing the aortic valve calcification, but the specificity is not satisfactory.