心脏超声参数积分系统对慢性左心室收缩功能减低心力衰竭患者一年再入院的风险评估

发布时间：2018-05-14 10:27

本文选题：超声心动描记术 + 心室功能障碍　；参考：《中国循环杂志》2017年12期

【摘要】：目的:本研究旨在建立并使用心脏超声参数积分系统(超声积分系统)对慢性左心室收缩功能减低(LVSD)心力衰竭(心衰)患者进行1年再入院风险评估。方法:收集并整理我院2007-01至2016-01期间连续9年慢性LVSD患者412例,以1年内再入院为本研究终点。412例患者常规超声心动图检查数据包括2007-01至2014-12用于建立超声积分系统280例,2015-01至2016-01用于超声积分系统的验证132例。依据采集的7项指标并分组:(1)左心室内径:0组(n=290)和1组(n=122);(2)二尖瓣反流:0组(n=203)、1组(n=138)和2组(n=71);(3)三尖瓣反流:0组(n=302)、1组(n=90)和2组(n=20);(4)LVEF:0组(n=272)和1组(n=140);(5)肺动脉收缩压:0组(n=282)和1组(n=130);(6)心包积液:0组(n=347)和1组(n=65);(7)胸腔积液:0组(n=261)、1组(n=86)和2组(n=65)。使用COX回归分析对超声参数进行筛查,并通过风险因子(HR)计算超声积分系统权重值,利用超声积分系统对LVSD患者1年内再入院进行分析,并与传统超声参数进行受试者工作特征(ROC)曲线分析比较。最后通过验证数据集对超声积分系统进行验证。结果:超声积分系统分值如下:左心室内径60 mm=1分,三尖瓣反流1组=1分,三尖瓣反流2组=3分,二尖瓣反流1组=2分,二尖瓣反流2组=4分,胸腔积液1组=2分,胸腔积液2组=3分,心包积液=1分。超声积分系统COX回归分析发现,不同组间LVSD患者1年内再入院率的HR分别为1.552、3.347、4.562,组间比较差异有统计学意义(P0.05)。超声积分系统的预测能力采用ROC曲线下面积(AUC)进行评价(建模数据:70.0%,95%CI:0.640~0.761;验证数据:70.4%,95%CI:0.616~0.792),最佳积分阈值为4分。结论:超声积分系统能够很好的预测LVSD患者1年再入院风险,并优于传统单项超声参数。
[Abstract]:Objective: to evaluate the risk of 1 year readmission in patients with heart failure (HF) with chronic left ventricular systolic dysfunction (LVSD). Methods: 412 cases of chronic LVSD patients from January 2007 to January 2016-January in our hospital were collected and sorted. Routine echocardiographic data of 412 patients with readmission within one year included 280 cases from January 2007 to December 2014-12 and 132 cases from 2015-01 to 2016-01 to establish an ultrasonic integral system. According to the 7 indexes collected and divided into two groups: 1) the left ventricular diameter of the left ventricle: 0 group (n 290) and 1 group of mitral regurgitation group 0 (n = 20 3) and 2 groups (n = 7 1 / 1) and 2 groups (n = 0 0) and 2 groups (n = 30 2) and 2 groups (n 20% 0) LVEF0 group nn 272) and 1 group n140 0) pulmonary artery systolic pressure 0 group n282) and 1% pulmonary artery systolic pressure group n282). Pericardial effusion (n = 130) pericardial effusion (n = 347) and group 1 (n = 26 ~ (1) n ~ (26) and group 2 (n ~ (65). The ultrasonic parameters were screened by COX regression analysis, and the weight of ultrasonic integral system was calculated by risk factor. The patients with LVSD were re-admitted to hospital within one year by using the ultrasonic integral system. And compared with the traditional ultrasonic parameters, the operating characteristics of the subjects were analyzed and compared with the ROC curve. Finally, the ultrasonic integration system is verified by the validation data set. Results: the scores of ultrasonic system were as follows: left ventricular diameter 60 mm = 1, tricuspid regurgitation 1 = 1, tricuspid regurgitation 2 = 3, mitral regurgitation 1 = 2, mitral regurgitation 2 = 4, pleural effusion 1 = 2. Pleural effusion 2 = 3, pericardial effusion 1. COX regression analysis showed that the HR of LVSD patients in different groups within one year were 1.552 卤3.347 and 4.562, respectively. There was significant difference between the two groups (P 0.05). The prediction ability of the ultrasonic integration system is evaluated by using the area under the ROC curve (modeling data: 70.0and 95 CI: 0.640 / 0.761respectively), and the verification data: 70.4 / 95CI0: 0.6160.792m, the optimum integral threshold is 4 minutes. Conclusion: the ultrasonic integral system can predict the risk of 1 year readmission of LVSD patients, and is superior to the traditional single ultrasound parameters.
【作者单位】：潍坊医学院临床医学院;山东大学附属千佛山医院心内科;山东大学;德州市人民医院急诊科;济南市中心医院心内科;烟台毓璜顶医院神经外科监护室;
【基金】：2014年山东省科技发展计划(2014GSF118187)
【分类号】：R541.6

【相似文献】