AECOPD患者右心功能不全的多维分级风险评分的构建

Construction of multidimensional Graded Risk Score for Right Ventricular Insufficiency in Patients with AECOPD

目的 构建以二维超声心动图、B型脑钠肽(BNP)、6分钟步行试验(6MWT)、呼吸困难量表(MMRC)为主要指标的多维分级评分,探讨其用于慢性阻塞性肺疾病急性加重期(AECOPD)患者右心功能不全风险评估的诊断效果.方法 选取2016年5月~2018年5月笔者医院急诊科收治的临床确诊的AECOPD患者249例.分别进行二维超声心动图、6MWT、MMRC、BNP等各指标测定.采用SPSS 19.0统计学软件进行t检验、秩和检验x2检验.构建右心功能不全的多维分级评分,并对右心功能不全风险进行预测,比较各指标受试者工作特征(ROC)曲线下面积(AUC).结果 二维超声心动图结果阳性率(37.8%)与BNP、6MWT、MMRC判定AECOPD患者发生右心功能不全的阳性率(分别为58.63%、82.73%、94.78%)间比较,差异均有统计学意义(P<0.05).依据右心功能不全评价赋分标准,建立一个分值范围为0 ~15分的评分表.多维分级风险评分、BNP、MMRC、6MWT评价AECOPD患者右心功能不全的ROC曲线的AUC分别为0.942(95% CI:0.912~0.972)、0.770(95% CI:0.708~0.831)、0.790(95% CI:0.734~0.846)、0.818(95% CI:0.766~0.869),差异有统计学意义(P<0.01).结论 AECOPD患者右心功能不全的多维分级风险评分能够较好系统地评估右心功能不全发生风险,其诊断效果优于单一指标,可应用于临床评估AECOPD患者右心功能不全风险.

Objective To construct a multi-dimensional grading scale with two-dimensional echocardiography, B-type brain natriuretic peptide(BNP), 6-minute walking test(6 MWT) and dyspnea scale as the main indicators, and to explore its diagnostic efficacy in the risk assessment of right ventricular insufficiency in AECOPD patients. Methods A total of 249 patients with clinically confirmed AECOPD admitted to the emergency department of our hospital from May 2016 to May 2018 were selected. Two-dimensional echocardiography, 6 MWT, MMRC, BNP and other indicators were measured. SPSS 19.0 statistical software was used for t test, rank sum test and chi-square test. Multidimensional grading score of right ventricular insufficiency was constructed, and the risk of right ventricular insufficiency was predicted. The area under the ROC curve(AUC) of each index was compared. Results The positive rate of two-dimensional echocardiography(37.8%) was significantly different from that of BNP, 6 MWT and MMRC(58.63%, 82.73% and 94.78% respectively) in determining right ventricular dysfunction in AECOPD patients(P<0.05). According to the evaluation criteria of right ventricular insufficiency, a scoring table with a scoring range of 0-15 was established. The ROC curves of multidimensional grading risk score, BNP, MMRC and 6 MWT for evaluating right ventricular dysfunction in AECOPD patients were 0.942(95% CI: 0.912-0.972), 0.770(95% CI: 0.708-0.831), 0.790(95% CI: 0.734-0.846), 0.818(95% CI: 0.766-0.869), respectively, with significant differences(P<0.01). Conclusion The multi-dimensional graded risk score of right ventricular insufficiency in AECOPD patients can evaluate the risk of right ventricular insufficiency more systematically, and its diagnostic efficacy is better than that of a single index. It can be used to evaluate the risk of right ventricular insufficiency in AECOPD patients.