呼出气体丙酮浓度对射血分数保留的心力衰竭的诊断价值

Diagnostic value of exhaled acetone in heart failure with preserved ejection fraction

目的研究呼出气体丙酮(EBA)浓度对射血分数保留的心力衰竭(HFpEF)患者的诊断价值。方法以52例健康体检者为对照组,164例HFpEF患者作为心力衰竭(HF)组,分析两组间EBA和N末端B型利钠肽原(NT-proBNP)浓度的差异及不同NYHA分级下EBA浓度的差异,应用受试者工作特征(ROC)曲线分析EBA浓度、NT-proBNP以及两者联合诊断HFpEF的灵敏度和特异度。结果HF组的EBA浓度[(0.156±0.285)mg/L]高于对照组[(0.025±0.023)mg/L],NT-proBNP[(3874.34±2913.06)pg/ml]高于对照组[(691.81±396.59)pg/ml],其差异均有统计学意义(均为P<0.05)。且NYHA分级越高,EBA浓度、NT-proBNP水平越高(P<0.05)。Spearman相关性分析示,EBA浓度与NT-proBNP、心功能分级、左室舒张末期容积、左心房容积指数、左心室质量指数和E/e’呈正相关(均为P<0.05),与左室射血分数、左室短轴缩短率和e’平均值呈负相关(均为P<0.05)。ROC曲线分析示EBA浓度和NT-proBNP对HFpEF诊断的曲线下面积分别为0.756和0.911,EBA浓度诊断敏感度为72.6%,特异度为84.6%。两者联合诊断的敏感度和特异度分别为90.9%和96.2%。结论EBA浓度对HFpEF有较高的诊断价值,与NT-proBNP联合检测可有效提高HFpEF的诊断效率。

Objective To study the diagnostic value of exhaled breath acetone(EBA)concentration in patients with heart failure with preserved ejection fraction(HFpEF).Methods Fifty-two healthy controls and 164 HFpEF patients were selected and the EBA and N-terminal pro B-type natriuretic peptide(NT-proBNP)concentration were measured and compared between the two groups.The diagnostic value of EBA concentration and NT-proBNP of HFpEF were evaluated by using receiver operating characteristic(ROC)curve.Results Both EBA[(0.156±0.285)mg/L]and NT-proBNP[(3874.34±2913.06)pg/ml]concentrations in HFpEF patients group were significantly higher than those in control group[(0.025±0.023)mg/L,(691.81±396.59)pg/ml,respectively,both P<0.05].And with the NYHA classification increased,the EBA concentration and NT-proBNP level(P<0.05)also increased.Spearman correlation analysis showed that EBA concentration was positively correlated with NT-proBNP,cardiac function grading,left ventricular end-diastolic volume,left atrial volume index,left ventricular mass index,E/E’(all P<0.05),negatively correlated with the mean values of left ventricular ejection fraction,left ventricular fraction shortening and E’(all P<0.05),and not significantly correlated with left ventricular end-systolic volume(P>0.05).ROC curve analysis showed that the area under the curve of EBA concentration and NT-proBNP for the diagnosis of HFpEF were 0.756 and 0.911,respectively.The sensitivity and specificity of EBA concentration diagnosis were 72.6%and 84.6%.The sensitivity and specificity of combined diagnosis were higher(90.9%and 96.2%,respectively).Conclusions EBA concentration has a diagnostic value for HFpEF.EBA concentration can be used as a reference index for the diagnosis of HFpEF patients.The combined detection of EBA concentration and NT-proBNP can effectively improve the diagnostic efficiency of HFpEF.