CAJ | 학술논문

目的:探讨左心室射血分数正常心力衰竭(heart failure with normal ejection fraction,HFNEF)患者的血浆B型利钠肽(B-type natriuretic peptide,BNP)、尿酸(uric acid,UA)水平与二尖瓣口舒张早期充盈速度/二尖瓣环水平舒张早期室壁运动速度(E/Em)的相关性；选择诊断HFNEF患者左心室充盈压升高的最佳指标.方法:比较顺序入选住院的HFNEF患者88例、舒张功能不全(diastolic dysfunction,DDF)患者63例及正常对照组20例的临床指标、超声心动图参数、血浆BNP和UA水平；以E/Em＞ 15为左心室充盈压升高界限值,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under curve,AUC),评价BNP及UA对左心室充盈压升高的诊断价值；选择诊断HFNEF患者左心室充盈压升高的最佳预测指标及诊断阈值.结果:HFNEF组的BNP、UA及E/Em较对照组及DDF组患者均明显升高(P＜0.01),多元线性回归分析显示BNP、左房直径是影响E/Em的独立相关因素(r=0.15,P＜0.01;r=1.09,P＜0.01)；经ROC曲线分析显示,BNP及UA诊断E/Em＞ 15的AUC分别为0.76(P＜0.01)和0.60(P=0.01),BNP是诊断HFNEF患者左心室充盈压升高的较好指标.以BNP=292 ng/L为阈值时诊断E/Em＞ 15的敏感性为68.1％,特异性为79.3％,阳性预测值为55.2％,阴性预测值为87.0％,准确性为76.3％；以UA=282 μmol/L为阈值时诊断E/Em＞ 15的敏感性为74.5％,特异性为55.6％,阳性预测值为38.4％,阴性预测值为85.3％,准确性为60.7％；联合BNP及UA诊断E/Em＞ 15的敏感性为53.2％,特异性为87.3％,阳性预测值为61.0％,阴性预测值为83.3％,准确性为78.0％.结论:HFNEF患者的BNP水平与E/Em明显相关,联合BNP及UA有利于量化评估HFNEF患者的左心室充盈压升高.
목적:탐토좌심실사혈분수정상심력쇠갈(heart failure with normal ejection fraction,HFNEF)환자적혈장B형리납태(B-type natriuretic peptide,BNP)、뇨산(uric acid,UA)수평여이첨판구서장조기충영속도/이첨판배수평서장조기실벽운동속도(E/Em)적상관성；선택진단HFNEF환자좌심실충영압승고적최가지표.방법:비교순서입선주원적HFNEF환자88례、서장공능불전(diastolic dysfunction,DDF)환자63례급정상대조조20례적림상지표、초성심동도삼수、혈장BNP화UA수평；이E/Em＞ 15위좌심실충영압승고계한치,회제수시자공작특정(receiver operating characteristic,ROC)곡선,계산곡선하면적(area under curve,AUC),평개BNP급UA대좌심실충영압승고적진단개치；선택진단HFNEF환자좌심실충영압승고적최가예측지표급진단역치.결과:HFNEF조적BNP、UA급E/Em교대조조급DDF조환자균명현승고(P＜0.01),다원선성회귀분석현시BNP、좌방직경시영향E/Em적독립상관인소(r=0.15,P＜0.01;r=1.09,P＜0.01)；경ROC곡선분석현시,BNP급UA진단E/Em＞ 15적AUC분별위0.76(P＜0.01)화0.60(P=0.01),BNP시진단HFNEF환자좌심실충영압승고적교호지표.이BNP=292 ng/L위역치시진단E/Em＞ 15적민감성위68.1％,특이성위79.3％,양성예측치위55.2％,음성예측치위87.0％,준학성위76.3％；이UA=282 μmol/L위역치시진단E/Em＞ 15적민감성위74.5％,특이성위55.6％,양성예측치위38.4％,음성예측치위85.3％,준학성위60.7％；연합BNP급UA진단E/Em＞ 15적민감성위53.2％,특이성위87.3％,양성예측치위61.0％,음성예측치위83.3％,준학성위78.0％.결론:HFNEF환자적BNP수평여E/Em명현상관,연합BNP급UA유리우양화평고HFNEF환자적좌심실충영압승고.