心衰超声指数联合血清学指标在心力衰竭患者病情评估中的应用价值

Application Value of Echocardiographic Heart Failure Index Combined with Serological Indexes in Evaluation of Patients with Heart Failure

目的探讨心衰超声指数联合血清学指标在心力衰竭患者病情评估中的应用价值.方法选取心力衰竭患者413例,根据纽约心脏病协会(NYHA)心功能分级情况分为心功能Ⅰ级组112例,心功能Ⅱ级组156例,心功能Ⅲ级组75例、心功能Ⅳ级组70例;收集同期健康体检者70名为对照组.应用超声心动图检查并评估心衰超声指数;采集受试者空腹肘静脉血5 mL,检测心肌肌钙蛋白、肌红蛋白、脑钠肽、心肌型脂肪酸结合蛋白(H-FABP)水平.对患者进行1 a的随访,根据心血管不良事件发生情况将患者分为不良心血管事件组(198例)和无不良心血管事件组(215例).结果心功能Ⅰ级组、心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组患者左室射血分数明显低于对照组,左室舒张末容积、左室收缩末容积、心衰超声指数明显高于对照组,随着心功能分级的增加上述改变更明显(P<0.05).不良心血管事件组患者左室射血分数水平明显低于无不良心血管事件组,左室舒张末容积、左室收缩末容积、心衰超声指数水平明显高于无不良心血管事件组(P<0.05).心功能Ⅰ级组、心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组患者心肌肌钙蛋白、肌红蛋白、脑钠肽、H-FABP水平明显高于对照组,随着心功能分级的增加上述改变更明显(P<0.05).不良心血管事件组患者心肌肌钙蛋白、肌红蛋白、脑钠肽、H-FABP水平明显高于无不良心血管事件组(P<0.05).心衰超声指数与心肌肌钙蛋白、肌红蛋白、脑钠肽、H-FABP联合检测对心力衰竭患者心血管不良事件的预测价值最高(AUC=0.875),灵敏度和特异度也高于各指标单独检测.结论心衰超声指数、心肌肌钙蛋白、肌红蛋白、脑钠肽、H-FABP水平与心力衰竭患者心功能分级相关,在预测心血管不良事件方面具有较高的应用价值,可用于患者病情评估.

ObjectiveTo explore the value of echocardiographic heart failure index combined with serological indexes in the evaluation of patients with heart failure.Method413 patients with heart failure were selected.According to the cardiac function classification of New York Heart Association(NYHA),they were divided into 112 cases in cardiac function class I group and 156 cases in cardiac function classⅡgroup;75 cases in gradeⅢgroup and 70 cases in gradeⅣgroup;70 healthy subjects in the same period were collected as the control group.Echocardiography and heart failure ultrasonic index were evaluated.Fasting elbow venous blood with 5mL was collected to detect the levels of cardiac troponin,myoglobin,brain natriuretic peptide and myocardial fatty acid binding protein(H-FABP).The patients were followed up for one year,the patients were divided into 198 cases in the adverse cardiovascular event group and 215 cases in the non-adverse cardiovascular event group.ResultsThe left ventricular ejection fraction of patients in cardiac function grade I group,cardiac function gradeⅡgroup,cardiac function classⅢgroup,cardiac function classⅣgroup was significantly lower than that in the control group,and the left ventricular end diastolic volume,left ventricular end systolic volume and heart failure ultrasonic index were significantly higher than those in the control group.The above changes were more obvious with the increase of cardiac function grade(P<0.05).The level of left ventricular ejection fraction in the adverse cardiovascular event group was significantly lower than that in the non-adverse cardiovascular event group,and the levels of left ventricular end diastolic volume,left ventricular end systolic volume and heart failure ultrasonic index were significantly higher than those in the non-adverse cardiovascular event group(P<0.05).Cardiac troponin,myoglobin,brain natriuretic peptide and H-FABP in cardiac function grade I group,cardiac function gradeⅡgroup,cardiac function classⅢgroup,cardiac function classⅣgroup were significantly higher than those in the control group.The above changes were more obvious with the increase of cardiac function grade(P<0.05).The levels of cardiac troponin,myoglobin,brain natriuretic peptide and H-FABP in the adverse cardiovascular event group were significantly higher than those in the non-adverse cardiovascular event group(P<0.05).The combined detection of heart failure ultrasonic index,cardiac troponin,myoglobin,brain natriuretic peptide and H-FABP has the highest predictive value for cardiovascular adverse events in patients with heart failure(AUC=0.875),and the sensitivity and specificity are also higher than those detected alone.ConclusionHeart failure ultrasonic index,cardiac troponin,myoglobin,brain natriuretic peptide and H-FABP are related to the classification of cardiac function in patients with heart failure.They have high application value in predicting adverse cardiovascular events and can be used for the evaluation of patients’condition.