中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
3期
206-211
,共6页
卢志南%孙兴国%胡盛寿%黄洁
盧誌南%孫興國%鬍盛壽%黃潔
로지남%손흥국%호성수%황길
心力衰竭,充血性%运动试验%利钠肽,脑%超声心动描记术%峰值摄氧量
心力衰竭,充血性%運動試驗%利鈉肽,腦%超聲心動描記術%峰值攝氧量
심력쇠갈,충혈성%운동시험%리납태,뇌%초성심동묘기술%봉치섭양량
Heart failure,congestive%Exercise test%Natriuretic peptide,brain%Echocardiography%Peak oxygen consumption
目的 应用心肺运动试验(CPET)的参数峰值摄氧量(peak (V)O2),血浆N末端B型利钠肽原(NT-proBNP)水平和超声心动图指标,评估慢性心力衰竭(CHF)患者心功能,并比较不同指标评价心功能的能力.方法 入选2010年10月至2013年7月入住阜外心血管病医院的CHF患者70例,左心室射血分数(LVEF)均＜40％.根据纽约心脏协会(NYHA)心功能分级,将入选病例分为两组,即NYHA心功能Ⅱ级组(17例)和NYHA心功能Ⅲ～Ⅳ级组(53例).收集两组患者的临床资料,静息状态下血浆NT-proBNP水平和超声心动图指标,均行CPET获得患者peak (V)O2.分析CHF患者peak (V)O2与NT-proBNP、超声心动图指标之间的相关性,并比较其判别出NYHA心功能Ⅲ～Ⅳ级CHF患者的能力.结果 NYHA心功能Ⅲ～Ⅳ级组患者左心房内径(LA)明显大于NYHA心功能Ⅱ级组[(51.3 ±7.2) mm比(44.0±7.4) mm,P＜0.001],NT-proBNP水平明显高于NYHA心功能Ⅱ级组(1 379～4 399 pmol/L比1 109 ～2 356 pmol/L,P＜0.01),peak (V)O2明显低于NYHA心功能Ⅱ级组[(13.4±3.5) ml·kg-1·min-1比(18.2±3.7)ml·kg-1·min-1,P ＜0.001].而两组患者间左心室舒张末期内径(LVEDD)和LVEF差异均无统计学意义.线性相关分析结果显示CHF患者peak (V)O2与NT-proBNP显著相关(r=-0.311,P＜0.01),但peak (V)O2和NT-proBNP与超声心动图指标LA、LVEDD和LVEF之间均无相关性.ROC曲线下面积分析显示peak (V)O2判别出中重度CHF患者(NYHA心功能Ⅲ～Ⅳ级)的效能最强(曲线下面积AUC=0.835,P＜0.001),其次是NT-proBNP(AUC=0.723,P＜0.01).结论 在反映患者CHF加重和筛选中重度CHF患者方面peak (V)O2比NT-proBNP和超声心动图指标更敏感.
目的 應用心肺運動試驗(CPET)的參數峰值攝氧量(peak (V)O2),血漿N末耑B型利鈉肽原(NT-proBNP)水平和超聲心動圖指標,評估慢性心力衰竭(CHF)患者心功能,併比較不同指標評價心功能的能力.方法 入選2010年10月至2013年7月入住阜外心血管病醫院的CHF患者70例,左心室射血分數(LVEF)均＜40％.根據紐約心髒協會(NYHA)心功能分級,將入選病例分為兩組,即NYHA心功能Ⅱ級組(17例)和NYHA心功能Ⅲ～Ⅳ級組(53例).收集兩組患者的臨床資料,靜息狀態下血漿NT-proBNP水平和超聲心動圖指標,均行CPET穫得患者peak (V)O2.分析CHF患者peak (V)O2與NT-proBNP、超聲心動圖指標之間的相關性,併比較其判彆齣NYHA心功能Ⅲ～Ⅳ級CHF患者的能力.結果 NYHA心功能Ⅲ～Ⅳ級組患者左心房內徑(LA)明顯大于NYHA心功能Ⅱ級組[(51.3 ±7.2) mm比(44.0±7.4) mm,P＜0.001],NT-proBNP水平明顯高于NYHA心功能Ⅱ級組(1 379～4 399 pmol/L比1 109 ～2 356 pmol/L,P＜0.01),peak (V)O2明顯低于NYHA心功能Ⅱ級組[(13.4±3.5) ml·kg-1·min-1比(18.2±3.7)ml·kg-1·min-1,P ＜0.001].而兩組患者間左心室舒張末期內徑(LVEDD)和LVEF差異均無統計學意義.線性相關分析結果顯示CHF患者peak (V)O2與NT-proBNP顯著相關(r=-0.311,P＜0.01),但peak (V)O2和NT-proBNP與超聲心動圖指標LA、LVEDD和LVEF之間均無相關性.ROC麯線下麵積分析顯示peak (V)O2判彆齣中重度CHF患者(NYHA心功能Ⅲ～Ⅳ級)的效能最彊(麯線下麵積AUC=0.835,P＜0.001),其次是NT-proBNP(AUC=0.723,P＜0.01).結論 在反映患者CHF加重和篩選中重度CHF患者方麵peak (V)O2比NT-proBNP和超聲心動圖指標更敏感.
목적 응용심폐운동시험(CPET)적삼수봉치섭양량(peak (V)O2),혈장N말단B형리납태원(NT-proBNP)수평화초성심동도지표,평고만성심력쇠갈(CHF)환자심공능,병비교불동지표평개심공능적능력.방법 입선2010년10월지2013년7월입주부외심혈관병의원적CHF환자70례,좌심실사혈분수(LVEF)균＜40％.근거뉴약심장협회(NYHA)심공능분급,장입선병례분위량조,즉NYHA심공능Ⅱ급조(17례)화NYHA심공능Ⅲ～Ⅳ급조(53례).수집량조환자적림상자료,정식상태하혈장NT-proBNP수평화초성심동도지표,균행CPET획득환자peak (V)O2.분석CHF환자peak (V)O2여NT-proBNP、초성심동도지표지간적상관성,병비교기판별출NYHA심공능Ⅲ～Ⅳ급CHF환자적능력.결과 NYHA심공능Ⅲ～Ⅳ급조환자좌심방내경(LA)명현대우NYHA심공능Ⅱ급조[(51.3 ±7.2) mm비(44.0±7.4) mm,P＜0.001],NT-proBNP수평명현고우NYHA심공능Ⅱ급조(1 379～4 399 pmol/L비1 109 ～2 356 pmol/L,P＜0.01),peak (V)O2명현저우NYHA심공능Ⅱ급조[(13.4±3.5) ml·kg-1·min-1비(18.2±3.7)ml·kg-1·min-1,P ＜0.001].이량조환자간좌심실서장말기내경(LVEDD)화LVEF차이균무통계학의의.선성상관분석결과현시CHF환자peak (V)O2여NT-proBNP현저상관(r=-0.311,P＜0.01),단peak (V)O2화NT-proBNP여초성심동도지표LA、LVEDD화LVEF지간균무상관성.ROC곡선하면적분석현시peak (V)O2판별출중중도CHF환자(NYHA심공능Ⅲ～Ⅳ급)적효능최강(곡선하면적AUC=0.835,P＜0.001),기차시NT-proBNP(AUC=0.723,P＜0.01).결론 재반영환자CHF가중화사선중중도CHF환자방면peak (V)O2비NT-proBNP화초성심동도지표경민감.
Objective To assess peak oxygen consumption (peak (V)O2) derived from cardiopulmonary exercise testing (CPET),concentrations of NT-proBNP and echocardiographic changes in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF,＜ 40％).Methods Seventy patients were included and divided into two groups according to the New York Heart Association (NYHA) classification:NYHA Ⅱ group (17 cases) and NYHA Ⅲ-Ⅳ group (53 cases).The basic clinical information,plasma concentration of NT-proBNP at rest,echocardiographic parameters and peak (V)O2 from CPET were compared between two groups.Correlation among peak (V)O2,NT-proBNP and echocardiographic parameters in this patient cohort was assessed and their abilities to discriminate the NYHA Ⅲ-Ⅳ grade were analyzed through c-Statistic.Results Left atrial diameter ((51.3 ±7.2) mm vs.(44.0 ±7.4) mm,P ＜0.001) was larger,plasma concentration of NT-proBNP (1 379-4 399 pmol/L vs.1 109-2 356 pmol/L,P ＜ 0.01) was higher and peak (V)O2 ((13.4 ± 3.5) ml · kg-1 · min 1 vs.(18.2 ± 3.7) ml · kg-1 · min-1,P ＜ 0.001) were significantly lower in NYHA Ⅲ-Ⅳ group than those in NYHA Ⅱ group.However,left ventricular end-diastolic diameter (LVEDD) and LVEF were similar between two groups.Peak (V)O2 correlated significantly with NT-proBNP (r =-0.311,P ＜ 0.01),but neither peak (V)O2 nor NT-proBNP correlated with echocardiographic parameters (LA,LVEDD and LVEF).ROC analysis showed that peak (V)O2 had the strongest discriminatory power for detecting NYHA Ⅲ-Ⅳ grade patients (AUC =0.835,P ＜0.001),followed by the NT-proBNP (AUC =0.723,P ＜0.01).Conclusion Peak (V)O2 is a more sensitive parameter to detect the disease aggravation (NYHA Ⅲ-Ⅳ grade) of the CHF patients with reduced LVEF compared to plasma NT-proBNP and echocardiographic parameters (LA,LVEDD,LVEF).
