2019 年第 12 期 第 14 卷

超声心动图联合血管紧张素Ⅱ检测用于高血压性心脏病诊断的价值探究

Diagnostic value of echocardiography combined with angiotensin Ⅱ for hypertensive heart disease

作者：周博雅黄仕颖陈文卫吴大嵘

英文作者：

单位：518033广东省深圳市，中山大学附属第八医院（深圳福田）超声科（周博雅、黄仕颖）；430061武汉大学医学院附属武汉大学人民医院超声科（陈文卫）；524003广东省湛江市，广东医学院第二附属医院中医科(吴大嵘)

英文单位：

关键词：高血压性心脏病；超声心动图；血管紧张素Ⅱ；敏感度；特异度

英文关键词：

• 摘要：

• 【摘要】目的    探讨超声心动图检查联合血清血管紧张素Ⅱ（AngⅡ）检测用于高血压性心脏病的诊断价值。方法    选取2017年1—12月中山大学附属第八医院（深圳福田）收治的高血压性心脏病患者100例作为研究对象（观察组），同期纳入100名来院健康体检者为对照组。分别对2组人群进行超声心动图检查及血清AngⅡ水平检测，通过受试者工作特征（ROC）曲线对2种手段单独及联合检测对高血压性心脏病的诊断价值进行分析。结果    通过对比分析发现，观察组经超声心动图检测的左心房前后直径、左心室舒张末期内径、左心室收缩末期内径、左心室质量、左心室射血分数、左心室短轴缩短率等各指标均存在异常，与对照组比较差异均有统计学意义（均P＜0.05）。不同高血压分级患者中，左心房扩大［高血压1级14.6%（6/41），2级56.8%（25/44），3级93.3%（14/15）］、主动脉粥样硬化比例［高血压1级29.3%（12/41），2级47.7%（21/44），3级46.7%（7/15）］之间存在明显差异（均P＜0.05）。观察组血清AngⅡ水平明显高于对照组［（44±7）ng/L比（26±5）ng/L］，差异有统计学意义（P＜0.001）。血清AngⅡ和超声心动图联合检测的ROC曲线下面积为0.869，明显大于二者单独检测（0.706、0.744）（均P＜0.001）；联合检测的敏感度为92.0%，明显高于单项检测（均P＜0.001）；特异度为71.0%，准确率为83.0%；联合检测的阳性预测值与阴性预测值均＞80%。结论    超声心动图检查联合血清AngⅡ检测可提高高血压性心脏病诊断的敏感度。

• 【Abstract】Objective    To analyze the value of combined echocardiography and serum angiotensin Ⅱ(AngⅡ) detection in the diagnosis of hypertensive heart disease. Methods    From January to December 2017, 100 patients with hypertensive heart disease admitted to the Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-Sen University were enrolled as observation group; 100 healthy people were enrolled as control group. Echocardiography was performed and the level of serum AngⅡ was detected in all subjects. Diagnostic efficiency of different means for hypertensive heart disease was analyzed using receiver operating characteristic（ROC） curve. Results    Patients in the observation group showed abnormal echocardiogram parameters such as left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular mass, left ventricular ejection fraction and fractional shortening as compared with the control group（all P＜0.05）. Among patients with different grades of hypertension there were significant differences in the proportions of left atrial dilatation［14.6%（6/41） for grade 1 vs 56.8%（25/44） for grade 2 vs 93.3%（14/15） for grade 3］ and aortic atherosclerosis［29.3%（12/41） for grade 1 vs 47.7%（21/44） for grade 2 vs 46.7%（7/15） for grade 3］（all P＜0.05）. Serum level of AngⅡ in the observation group was significantly higher than that in the control group［（44±7）ng/L vs （26±5）ng/L］（P＜0.001）. Combining serum AngⅡ and echocardiography showed a larger area under ROC curve than separate diagnosis(0.869 vs 0.706, 0.744; both P＜0.001）. Diagnostic sensitivity of combined detection(92.0%) was significantly higher than that of separate methods（P＜0.001）. Diagnostic specificity was 71.0% and the accuracy was 83.0%. Positive and negative predictive values of combined detection were more than 80%. Conclusion    Echocardiography combined with serum AngⅡ can improve the diagnostic sensitivity for hypertensive heart disease.