超声心动图对慢性肾病成年患者心力衰竭和死亡的预测价值

Value of echocardiography in predicting heart failure and death in adult patients with chronic kidney disease

目的 探讨超声心动图影像指标对慢性肾脏病(chronic kidney disease, CKD)成年患者心力衰竭(heart failure, HF)和死亡的预测效果。方法 选取2016年1月—2018年6月永煤集团总医院治疗的CKD患者357例,应用Logisitic回归分析探讨影响患者HF和死亡的相关因素,应用接收者工作特征曲线(receiver operation characteristic, ROC)分析探讨超声心动图指标对患者HF和死亡的预测价值。结果 (1)年龄、高脂血症、左室舒张末期容积指数(left ventricular end-diastolic volume index, LVEDVI)、左心室舒张末期内径(left ventricular internal diameter-diastole, LVIDD)、左室射血分数(left ventricular ejection fraction, LVEF)、左心室质量指数(left ventricular mass index, LVMI)、室间隔舒张末期厚度(interventricular septal thickness at diastole, IVSD)及左室几何形态是CKD患者慢性HF发病的影响因素。(2)年龄、高血压、血红蛋白、LVEDVI、LVIDD、LVEF、LVMI、IVSD、RWT及左室几何形态是CKD患者死亡的影响因素。(3) CKD患者HF发病的预测模型=-0.203+0.051×LVEDVI(mL/m^(2))+0.070×LVIDD(mm)-0.069×LVEF(%)+0.023×LVMI(g/m^(2))+0.083×IVSD(mm)+0.544×左室几何形态。(4) CKD患者死亡的预测模型=0.101+0.063×LVEDVI+0.076×LVIDD-0.082×LVEF+0.029×LVMI+0.087×IVSD+0.886×左室几何形态。(5) LVEDVI、LVIDD、LVEF、LVMI、IVSD、左室几何形态单独及联合应用预测CKD患者HF:ROC-AUC(0.95CI)分别为:0.682(0.360~0.985)、0.702(0.390~0.989)、0.700(0.471~0.918)、0.674(0.399~0.950)、0.683(0.402~0.950)、0.695(0.459~0.929)、0.850(0.702~0.978)。(6) LVEDVI、LVIDD、LVEF、LVMI、IVSD、RWT、左室几何形态单独及联合应用预测CKD患者死亡:ROC-AUC(0.95CI)分别为:0.677(0.372~0.962)、0.673(0.361~0.986)、0.666(0.382~0.946)、0.692(0.407~0.961)、0.674(0.368~0.979)、0.658(0.386~0.912)、0.681(0.371~0.988)、0.834(0.722~0.919)。结论 基线超声心动图参数与CKD患者HF发病率和死亡率的风险增加独立相关,但预测价值较低。

Objective To investigate the effect of echocardiography in predicting HF and death in adult patients with CKD.Methods A total of 357 CKD patients treated in the Yongmei Group General Hospital from January 2016 to June 2018 were selected. Logisitic regression analysis was applied to explore the relevant factors affecting HF and death of patients. receiver operation characteristic was applied. To investigate the predictive value of echocardiographic indexes for HF and death.Results(1) Age, hyperlipidemia, LVEDVI, LVIDD, LVEF, LVMI, IVSD and left ventricular geometry were the influencing factors of chronic HF in CKD patients.(2) Age, hypertension, hemoglobin, LVEDVI, LVIDD, LVEF, LVMI, IVSD, RWT and left ventricular geometry were the influencing factors of death in CKD patients.(3) Prediction model of HF incidence in CKD patients=-0.203+0.051 × LVEDVI(mL/m^(2))+0.070 × LVIDD(mm)-0.069 × LVEF(%) +0.023 × LVMI(g/m^(2)) +0.083 × IVSD(mm) +0.544 × Left ventricular geometry.(4) Prediction model of death of CKD patients=0.101+0.063 × LVEDVI +0.076 × LVIDD-0.082 × LVEF +0.029 × LVMI +0.087 × IVSD +0.886 × Left ventricular geometry.(5) LVEDVI, LVIDD, LVEF, LVMI, IVSD, and left ventricular geometry alone and in combination predicted HF: ROC-AUC(0.95CI) in CKD patients as 0.682(0.360~0.985), 0.702(0.390~0.989), 0.700(0.471~0.918), 0.674(0.399~0.950), 0.683(0.402~0.950), 0.695(0.459~0.929), and 0.850(0.702~0.978), respectively.(6) LVEDVI, LVIDD, LVEF, LVMI, IVSD, RWT, and left ventricular geometry alone or in combination predicted the death of CKD patients: ROC-AUC(0.95CI) were 0.677(0.372~0.962), 0.673(0.361~0.986), 0.666(0.382~0.946), 0.692(0.407~0.961), 0.674(0.368~0.979), 0.658(0.386~0.912), 0.681(0.371~0.988), and 0.834(0.722~0.919), respectively.Conclusion The baseline echocardiographic parameters are independently associated with the increased risk of HF incidence rate and mortality in CKD patients, but their predictive value is low.