经胸壁超声心动图结合BNP对全身感染患者心脏功能水平的研究

Evaluation of transthoracic echocardiography combined with BNP for cardiac function in patients with systemic infections

目的探索利用经胸壁超声心动图结合患者血清脑钠肽(BNP)对评价全身感染患者心脏功能水平的价值。方法回顾性分析医院2015年1月-2017年1月收治的84例全身感染患者,根据是否发生心力衰竭分为心力衰竭组36例和对照组48例。采用经胸壁超声心动图检查心功能Killip分级和左室舒张末期内径(LVIDD)和左心室射血分数(LVEF)。检测血清BNP水平。分析两组患者血清BNP水平、LVEF和LVIDD的差异。分析心力衰竭组患者各指标与心功能Killip分级之间的相关性;不同检查方法对诊断患者全身感染合并心力衰竭以及评估不同心功能Killip分级的敏感性和特异性比较。结果心力衰竭组患者LVEF为(40.38±10.49)%低于对照组(52.57±11.93)%(P<0.05),心力衰竭组LVIDD(62.03±9.74)mm和血清BNP水平(8739.62±4722.73)ng/L均高于对照组的(52.82±8.33)mm和(4269.84±2389.18)ng/L(P<0.05)。心力衰竭组患者的血清BNP水平、LVIDD与Killip心功能分级呈正相关(P<0.05);LVEF与Killip心功能分级呈负相关(P<0.05)。胸壁超声结合BNP检查患者心力衰竭的敏感性为91.67%,特异性为85.42%,均高于单纯血清BNP检查或胸壁超声检查(P<0.05)。经胸壁超声结合BNP检查对心力衰竭组患者不同心功能Killip分级的检测敏感性与特异性均高于单纯使用经胸壁超声检查或血清BNP检查(P<0.01)。结论经胸壁超声心动图结合BNP对评估全身感染心功能水平具有较高的敏感性和特异性。

OBJECTIVE To explore the value of transthoracic echocardiography combined with BNP in assessing the level of cardiac function in patients with systemic infections.METHODS A total of 84 patients with systemic infec- tions who underwent treatment from Jan. 2015 to Jan. 2017 were retrospectively analyzed, and were divided into heart failure group （36 cases） and control group （48 cases） according to whether or not heart failure occurred. Cardiac function Killip grading, left ventricular end diastolic diameter （LVIDD） and left ventricular ejection frac- tion （LVEF） were examined by transthoracic echocardiography. Blood samples were collected and serum BNP lev- els were measured. The levels of serum BNP, LVEF and LVIDD were analyzed in the two groups. The relation- ship between the Killip classification of cardiac function and the indexes among patients with heart failure was aba- lyzed, and the sensitivity and specificity of different methods for the diagnosis of heart failure and the sensitivity and specificity of different methods for the diagnosis of heart failure and cardiac function Killip grading were com- pared.RESULTS The level of LVEF was （40.38±10.49）% in patients with heart failure, which was significantly lower than （52.57 ±11.93）% in control group （P〈0.05）, levels of LVIDD and serum BNP in heart failuregroup were （62.03±9.74） mm and （8739.62±4722.73） ng/L, which were significantly higher than （52.57± 11. 93） mm and （4269.8±2389.18） ng/L in the control group（P〈0.05）. The serum BNP level and LVIDD were positively correlated with Killip cardiac function grading（P〈0.01）, and LVEF was negatively correlated with Kil- lip＇s cardiac function score in heart failure group （P〈0.05）. The sensitivity and specificity of transthoracic echo- cardiography combined with BNP for heart failure were 91.67% and 85.42%, respectively, which were signifi cantly higher than those of BNP examination or transthoracic echocardiography （P 〈0.05）. The sensitivity and specificity of transthoracic echocardiography combined with BNP for Killip grading in patients with heart failure were significantly higher than those using BNP examination or transthoracic echocardiography （P〈 0.05 ）. CONCLUSION Transthoracic echocardiography combined with BNP has great sensitivity and specificity in assess ing the level of cardiac function in patients with systemic infections.