双源64层螺旋CT结合心肌营养素-1对于舒张期心衰的诊断价值

The prediction value analysis of dual source 64 slice spiral CT combined with cardiotrophirr-1 in the diagnosis of diastolic heart failure

目的:探讨双源64层螺旋CT结合心肌营养素-1对于舒张期心衰的诊断价值。方法:选择2014年10月~2016年10月在河北省三河市医院诊断舒张期心衰患者60例作为研究组,同期选择不稳定心绞痛患者60例作为对照组。入院后24h内给予酶联免疫吸附法检测血浆营养素-1(CT-1),双抗体免疫荧光法检查血浆氨基末端钠尿肽(NT-pro BNP)水平,采用64层双源螺旋CT(64-MDCT)行冠状动脉血管成像,利用左室功能评估软件在左心室长、短轴方向勾勒左心室内膜面,计算左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV),测量二尖瓣口舒张早期、晚期血流速度峰值(E、A),二尖瓣舒张早期最大组织运动速度(Ea),计算E/A、E/Ea比值。比较2组患者血浆CT-1、BNP水平以及影像学指标差异。Spearman相关分析比较血浆CT-1、BNP、E/Ea比值间相关性。采用受试者工作特征曲线(ROC)分析血浆CT-1与E/Ea比值对于舒张期心衰诊断的预测价值。结果:研究组与对照组比较,血浆CT-1、NT-pro BNP、E/Ea比值水平明显升高,E/A比值降低,2组比较差异有统计学意义。LVEDV、LVESV指标差异无统计学意义。血浆CT-1、E/Ea与BNP比值之间呈直线正相关。2组患者64-MDCT检测左室舒张功能各指标略高于M型超声心动图对应指标,但差异无统计学意义。两种不同检查方法心脏功能各指标高度相关。血浆CT-1以71.5 pg/m L,E/Ea比值>8.0为截断值,预测舒张期心衰诊断的灵敏度为(68.79%,86.34%),特异度为(65.29%,89.02%)。ROC曲线下面积分为。结论:双源64层螺旋CT可用于舒张期心衰的定量评价,其E/Ea比值、血浆心肌营养素-1与氨基末端脑钠尿肽水平存在较好相关性。E/Ea比值与血浆心肌营养素-1水平升高对于舒张期心衰具有一定诊断价值。

Objective To explore the clinical value of 64 slice spiral CT with cardiotrophin-1 in the diagnosis of diastolic heart failure. Methods From October 2014 to October 2016, All sixty patients diagnosed with diastolic heart failure were selected as the study group, Meanwhile, sixty patients with unstable angina were selected as the control group. After admission, the plasma cardiotrophin-1(CT-1) were detected by enzyme-linked immunosorbent assay method within 24 hours and the plasma N-terminal natriuretic peptide(NT-pro BNP) levels were also detected by double antibody immunofluorescence method, coronary angiography was done by using 64 slice dual source spiral CT(64-MDCT) technology. By using left ventricular function evaluation software, Left ventricular inner membrane area was outlined in two dimensions of the left ventricular long and short axis. The indexes of Left ventricular end diastolic volume(LVEDV), end systolic volume(LVESV), early and late diastolic mitral peak velocity(E, A) and early diastolic mitral velocity(Ea) were measured, E/A and E/Ea ratio was calculated. Plasma CT-1, BNP levels and imaging parameters were compared between the two groups. Correlation of plasma CT-1, BNP and E/Ea ratios were compared by Spearman correlation analysis. The receiver operating characteristic curve(ROC) was used to predict the predictive value of plasma CT-1 and E/Ea ratio in the diagnosis of diastolic heart failure. Results Compared with the control group, the levels of plasma CT-1, NT-pro BNP and E/Ea were significantly increased, and the ratio of E/A was decreased in the study group, the difference between the two groups was statistically significant. There was no significant difference between LVEDV and LVESV. Linear positive correlation was observed between plasma CT-1, E/Ea and BNP. The indexes of left ventricular diastolic function detected by using 64 slice dual source spiral CT(64-MDCT) technology in the two groups were slightly higher than that of the M-type echocardiography, but the difference was not statistically significant. The cardiac function indexes were highly correlated respectively. If the plasma CT-1 was equal to 71.5(pg/m L) and E/Ea ratio> 8 as cutoff value, the prediction sensitivity of diastolic heart failure diagnosis respectively were 68.79% and 86.34% and the specificity were 65.29% and 89.02%. The area under the curve of ROC curve were 0.704, 0.841 respectively. Conclusion Dual-source 64-slice spiral CT can be used for quantitative assessment of diastolic heart failure, the E/Ea ratio, plasma cardiotrophin-1 and N-terminal brain natriuretic peptide levels were better correlated. The increase of the E/Ea ratio and plasma cardiotrophin-1 level has certain value in the diagnosis of diastolic heart failure.