本文選題：超聲心動(dòng)描記術(shù) + 心室功能障礙�。� 參考：《中國循環(huán)雜志》2017年12期

【摘要】：目的:本研究旨在建立并使用心臟超聲參數(shù)積分系統(tǒng)(超聲積分系統(tǒng))對慢性左心室收縮功能減低(LVSD)心力衰竭(心衰)患者進(jìn)行1年再入院風(fēng)險(xiǎn)評估。方法:收集并整理我院2007-01至2016-01期間連續(xù)9年慢性LVSD患者412例,以1年內(nèi)再入院為本研究終點(diǎn)。412例患者常規(guī)超聲心動(dòng)圖檢查數(shù)據(jù)包括2007-01至2014-12用于建立超聲積分系統(tǒng)280例,2015-01至2016-01用于超聲積分系統(tǒng)的驗(yàn)證132例。依據(jù)采集的7項(xiàng)指標(biāo)并分組:(1)左心室內(nèi)徑:0組(n=290)和1組(n=122);(2)二尖瓣反流:0組(n=203)、1組(n=138)和2組(n=71);(3)三尖瓣反流:0組(n=302)、1組(n=90)和2組(n=20);(4)LVEF:0組(n=272)和1組(n=140);(5)肺動(dòng)脈收縮壓:0組(n=282)和1組(n=130);(6)心包積液:0組(n=347)和1組(n=65);(7)胸腔積液:0組(n=261)、1組(n=86)和2組(n=65)。使用COX回歸分析對超聲參數(shù)進(jìn)行篩查,并通過風(fēng)險(xiǎn)因子(HR)計(jì)算超聲積分系統(tǒng)權(quán)重值,利用超聲積分系統(tǒng)對LVSD患者1年內(nèi)再入院進(jìn)行分析,并與傳統(tǒng)超聲參數(shù)進(jìn)行受試者工作特征(ROC)曲線分析比較。最后通過驗(yàn)證數(shù)據(jù)集對超聲積分系統(tǒng)進(jìn)行驗(yàn)證。結(jié)果:超聲積分系統(tǒng)分值如下:左心室內(nèi)徑60 mm=1分,三尖瓣反流1組=1分,三尖瓣反流2組=3分,二尖瓣反流1組=2分,二尖瓣反流2組=4分,胸腔積液1組=2分,胸腔積液2組=3分,心包積液=1分。超聲積分系統(tǒng)COX回歸分析發(fā)現(xiàn),不同組間LVSD患者1年內(nèi)再入院率的HR分別為1.552、3.347、4.562,組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。超聲積分系統(tǒng)的預(yù)測能力采用ROC曲線下面積(AUC)進(jìn)行評價(jià)(建模數(shù)據(jù):70.0%,95%CI:0.640~0.761;驗(yàn)證數(shù)據(jù):70.4%,95%CI:0.616~0.792),最佳積分閾值為4分。結(jié)論:超聲積分系統(tǒng)能夠很好的預(yù)測LVSD患者1年再入院風(fēng)險(xiǎn),并優(yōu)于傳統(tǒng)單項(xiàng)超聲參數(shù)。
[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 鹵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.
【作者單位】： 濰坊醫(yī)學(xué)院臨床醫(yī)學(xué)院;山東大學(xué)附屬千佛山醫(yī)院心內(nèi)科;山東大學(xué);德州市人民醫(yī)院急診科;濟(jì)南市中心醫(yī)院心內(nèi)科;煙臺毓璜頂醫(yī)院神經(jīng)外科監(jiān)護(hù)室;
【基金】：2014年山東省科技發(fā)展計(jì)劃(2014GSF118187)
【分類號】：R541.6

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