肺阻抗血流图对老年慢性心功能不全的诊断价值-现代医学

肺阻抗血流图对老年慢性心功能不全的诊断价值

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院老年科, 江苏南京 210009

分类号：R541.6;R540.6

出版年·卷·期（页码）：2018·46·第十一期（1262-1266）

摘要：

目的：探讨肺阻抗血流图对老年慢性心功能不全的诊断价值。方法：选取50例年龄>65岁的临床诊断为慢性心功能不全的患者为研究组，根据NYHA心功能分级（Ⅰ～Ⅳ级）将其分为4组。另选取23例无心功能不全的老年患者作为对照组。采用WA-820数字阻抗血流图仪检测并记录参数的数值，同时检测血浆NT-proBNP水平。结果：与对照组相比，心功能不全组患者肺阻抗血流图基础阻抗值Z₀、阻抗室缩波波幅HS、右心射血前期指数Q-BI、右心射血期指数B-YI、右心衰指数P₂-Y、心肌紧张指数Q-B/B-Y、左心舒张功能指标O/C等显著升高，差异均有统计学意义（t值分别为3.913、4.761、-5.466、5.529、6.114、-3.901、-6.431，P<0.05）。心功能Ⅰ、Ⅱ级组与对照组比较，肺阻抗血流图监测指标差异无统计学意义（P>0.05）；心功能Ⅲ、Ⅳ级组与对照组比较，指标Z₀、HS 、Q-BI、B-YI、P₂-Y、Q-B/B-Y、O/C差异均有统计学意义（P<0.05）。NT-proBNP诊断慢性心功能不全时曲线下面积（AUC）为0.878，95%可信区间为0.791~0.966；其灵敏度为72%，特异度为87%。肺阻抗血流图诊断慢性心功能不全时AUC为0.869，95%可信区间为0.748~0.990；其灵敏度为84%，特异度为78%。两者并联试验，灵敏度为88%，特异度为69%；串联试验，灵敏度为68%，特异度为96%。结论：肺阻抗血流图可作为评估老年慢性心功能不全患者心功能状态的手段，联合NT-proBNP等可进一步提高对老年患者心功能状态评估的诊断特异性，对老年慢性心功能不全患者的诊治具有一定的临床应用价值。

Objective:To explore the value of Impedance Pulmonary Rheogram in clinical diagnosis of elderly patients with chronic cardiac insufficiency. Methods:50 patients over 65 years old with chronic cardiac insufficiency were selected and divided into four groups according to NYHA, 23 elderly patients without disease were allocated into control group. WA-820 digital impedance rheometer was used to detect and collect the data. NT-proBNP level was tested and analyzed. Results:Comparedwith the control group, the indexes of Z₀, HS, Q-BI, B-YI, P₂-Y, Q-B/B-Y, O/C were significantly different (t=3.913, 4.761, -5.466, 5.529, 6.114, -3.901, -6.431,P<0.05). The AUC of the diagnosis with NT-proBNP level was 0.878. The sensitivity was 72%, and the specificity was 87%. The AUC of the diagnosis with Impedance Pulmonary Rheogram was 0.869. The sensitivity was 84%, and the specificity was 78%. NT-proBNP and Impedance Pulmonary Rheogram were combined to evaluate the state of heart function. If the test was parallel, the sensitivity was 88% and the specificity was 69%. If the test was in series, the sensitivity was 68% and the specificity was 96%. There was no significant statistical significance of the indexes of Impedance Pulmonary Rheogram in the cardiac function Ⅰ-Ⅱ group (P>0.05). There were significant differences between the cardiac function Ⅲ-Ⅳ group (P<0.05). Conclusion:Cardiac function status can be assessed with Impedance Pulmonary Rheogram in elderly patients with chronic heart failure. Digital impedance angiography combined with BNP/NT-proBNP can improve the diagnostic efficiency of cardiac function assessment in elderly patients.

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