中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
5期
1936-1940
,共5页
心力衰竭%超声心动描记术,多普勒%利钠肽,脑%左心房容积
心力衰竭%超聲心動描記術,多普勒%利鈉肽,腦%左心房容積
심력쇠갈%초성심동묘기술,다보륵%리납태,뇌%좌심방용적
Heart failure%Echocardiography,Doppler%Natriuretic peptide,brain%Left atrial volume
目的比较组织多普勒及左心房容积对左心室射血分数正常的心力衰竭的诊断价值，评价这两种超声诊断方法的临床意义。方法按照中国心力衰竭协会舒张性心力衰竭简化标准，选择左心室射血分数正常（EF≥50％）且血清B型尿钠肽（BNP）≥200 pg/ml的心力衰竭患者30例（HFNEF组），正常对照组病例（排除心肺疾病）32例，应用超声心动图测量二尖瓣舒张早期血流速度峰值（ E峰）、舒张晚期血流速度峰值（A峰）；组织多普勒测量二尖瓣环运动舒张早期速度峰值（E′峰）、舒张晚期速度峰值（A′峰），分别计算E/A比值、E′/A′及E/E′比值；分别测量左心房长轴的直径、左心房的上下径、左右径，计算左心房容积（ LAV）。结果 HFNEF组E/A比值1.12±0.58、E′/A′比值0.63±0.31，对照组E/A比值1.01±0.41、E′/A′比值0.63±0.22，两组比较差异无统计学意义（ P＞0.05）；E/E′比值HFNEF 组为16.05±5.19、对照组为10.78±2.07，两组比较差异有统计学意义（P＜0.001），LAV在HFNEF组为（55.83±13.67）cm3、对照组为（38.11±10.68）cm3，两组之间比较差异有统计学意义（P＜0.001）。 E/E′比值、LAV两者的诊断准确度均为中等偏高；E/E′在截断点为12.93时，灵敏度为0.65，特异度为0.91，LAV在截断点39.12 cm3水平时，灵敏度为0.95，特异度为0.73。结论 E/E′比值、LAV超声诊断结合临床症状、体征及生化学指标对于诊断射血分数正常的心力衰竭有较高的准确度和可信度。
目的比較組織多普勒及左心房容積對左心室射血分數正常的心力衰竭的診斷價值，評價這兩種超聲診斷方法的臨床意義。方法按照中國心力衰竭協會舒張性心力衰竭簡化標準，選擇左心室射血分數正常（EF≥50％）且血清B型尿鈉肽（BNP）≥200 pg/ml的心力衰竭患者30例（HFNEF組），正常對照組病例（排除心肺疾病）32例，應用超聲心動圖測量二尖瓣舒張早期血流速度峰值（ E峰）、舒張晚期血流速度峰值（A峰）；組織多普勒測量二尖瓣環運動舒張早期速度峰值（E′峰）、舒張晚期速度峰值（A′峰），分彆計算E/A比值、E′/A′及E/E′比值；分彆測量左心房長軸的直徑、左心房的上下徑、左右徑，計算左心房容積（ LAV）。結果 HFNEF組E/A比值1.12±0.58、E′/A′比值0.63±0.31，對照組E/A比值1.01±0.41、E′/A′比值0.63±0.22，兩組比較差異無統計學意義（ P＞0.05）；E/E′比值HFNEF 組為16.05±5.19、對照組為10.78±2.07，兩組比較差異有統計學意義（P＜0.001），LAV在HFNEF組為（55.83±13.67）cm3、對照組為（38.11±10.68）cm3，兩組之間比較差異有統計學意義（P＜0.001）。 E/E′比值、LAV兩者的診斷準確度均為中等偏高；E/E′在截斷點為12.93時，靈敏度為0.65，特異度為0.91，LAV在截斷點39.12 cm3水平時，靈敏度為0.95，特異度為0.73。結論 E/E′比值、LAV超聲診斷結閤臨床癥狀、體徵及生化學指標對于診斷射血分數正常的心力衰竭有較高的準確度和可信度。
목적비교조직다보륵급좌심방용적대좌심실사혈분수정상적심력쇠갈적진단개치，평개저량충초성진단방법적림상의의。방법안조중국심력쇠갈협회서장성심력쇠갈간화표준，선택좌심실사혈분수정상（EF≥50％）차혈청B형뇨납태（BNP）≥200 pg/ml적심력쇠갈환자30례（HFNEF조），정상대조조병례（배제심폐질병）32례，응용초성심동도측량이첨판서장조기혈류속도봉치（ E봉）、서장만기혈류속도봉치（A봉）；조직다보륵측량이첨판배운동서장조기속도봉치（E′봉）、서장만기속도봉치（A′봉），분별계산E/A비치、E′/A′급E/E′비치；분별측량좌심방장축적직경、좌심방적상하경、좌우경，계산좌심방용적（ LAV）。결과 HFNEF조E/A비치1.12±0.58、E′/A′비치0.63±0.31，대조조E/A비치1.01±0.41、E′/A′비치0.63±0.22，량조비교차이무통계학의의（ P＞0.05）；E/E′비치HFNEF 조위16.05±5.19、대조조위10.78±2.07，량조비교차이유통계학의의（P＜0.001），LAV재HFNEF조위（55.83±13.67）cm3、대조조위（38.11±10.68）cm3，량조지간비교차이유통계학의의（P＜0.001）。 E/E′비치、LAV량자적진단준학도균위중등편고；E/E′재절단점위12.93시，령민도위0.65，특이도위0.91，LAV재절단점39.12 cm3수평시，령민도위0.95，특이도위0.73。결론 E/E′비치、LAV초성진단결합림상증상、체정급생화학지표대우진단사혈분수정상적심력쇠갈유교고적준학도화가신도。
Objective To evaluate the clinical significance of the two parameters , tissue doppler imaging and left atrial volume for diagnosing heart failure with normal left ventricular ejection fraction .Methods According to China Association of Heart Failure diastolic heart failure simplify diagnostic criteria ,a total of 30 patients with the heart failure of normal ejection fraction ( EF≥50%) and Serum B-type natriuretic peptide≥200 pg/ml were recruited.32 matched cases were recruited into the control group .The early peak of diastolic flow velocity (E peak) and the late peak of diastolic flow velocity (A peak)of the mitral were detected by echocardiography ,the early peak of diastolic velocity ( E ′peak ) and late peak of diastolic velocity ( A′peak ) of the mitral were measured by Tissue Doppler Imaging,and then we calculated E/A ratio,E′/A′,E/E ′ratio respectively,parasternal long axis left atrial diameter ,apical four-chamber left atrial longitudinal diameter and trans diameter were measured to calculate left atrial volume( LAV) size.Results There were no significant differences in the mitral inflow E/A ratio and tissue Doppler imaging mitral annulus E′/A′ratio between the HFNEF group and control group ( E/A ratio 1.12 ±0.58 vs.1.01 ± 0.41,E′/A′ratio 0.63 ±0.31 vs.0.63 ±0.22,P>0.05),but in E/E′ratio and the left atrial volume,there were statistically significant differences between the two groups [E/E′ratio 16.05 ±5.19 vs.10.78 ±2.07,LAV(55.83 ± 13.67)cm3 vs.(38.11 ±10.68)cm3,P<0.001].E/E′ratio and left atrial volume were both diagnostic accuracy of medium to high,the cut off point of E/E′was 12.93,the sensitivity was 0.65,specificity was 0.91,and the cut-off points of LAV was 39.12 cm3 level, the sensitivity was 0.95, specificity was 0.73.Conclusions The two parameters:E/E′ratio and LAV combined with clinical symptoms ,signs and biochemical markers ,are demonstrated to have a higher accuracy and reliability for diagnosis of heart failure with normal ejection fraction .
