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目的探讨X线第一前肋间肺静脉直径(PVDFAI)与肺毛细血管嵌压(PCWP)的关系及对心力衰竭(CHF)的诊断价值。方法入选住院呼吸困难患者195例,正常健康组67例,测定肺毛细血管嵌压(PCWP)并行后前位X线胸片检查,测量PVDFAI。以PCWP>12mmHg作为左心功能不全的诊断标准,将患者分为心衰组和肺源性呼吸困难组。计算PVDFAI诊断心衰的不同截值的敏感性、特异性、准确性。结果正常对照组PVDFAI(1.34±0.49)mm与肺源性呼吸困难组PVDFAI(1.43±0.37)mm差异无显著统计学意义(q=0.2700,P>0.05)。心源性呼吸困难组PVDFAI(2.49±0.93)mm与肺源性呼吸困难组和正常对照组比较均有明显增宽(q=17.0676,P<0.01;q=15.1143,P<0.01)。PVD-FAI与PCWP密切相关(r=0.388,P=0.000)。多元Logistic回归分析表明胸片PVDFAI是CHF的独立预测因子(P=0.000,比数比28.103)。PVDFAI判定肺源性呼吸困难或心衰,其曲线下面积95.24%(95%可信区间,91.73%~98.85%)。判断左心功能不全的PVDFAI最佳截值为2.5 mm,其诊断左心功能不全的敏感度97.17%,特异度93.26%,准确度95.38%。结论第一前肋间肺静脉直径可用以识别有、无肺静脉高压,对诊断心衰有价值。
Objective To investigate the relationship between the first anterior intercostal pulmonary vein diameter (PVDFAI) and pulmonary capillary intrusion (PCWP) and the diagnostic value of heart failure (CHF). Methods 195 hospitalized patients with dyspnea and 67 normal controls were enrolled in this study. Pulmonary capillary intima pression (PCWP) was performed in combination with anteroposterior X-ray examination to measure PVDFAI. With PCWP> 12mmHg as a diagnostic criteria for left ventricular dysfunction, patients were divided into heart failure group and pulmonary dyspnea group. Calculate the sensitivity, specificity and accuracy of different cutoffs of PVDFAI in diagnosing heart failure. Results There was no significant difference between PVDFAI (1.34 ± 0.49) mm in normal control group and PVDFAI (1.43 ± 0.37) mm in pulmonary dyspnea group (q = 0.2700, P> 0.05). The level of PVDFAI in cardiogenic dyspnea group (2.49 ± 0.93) mm was significantly higher than that in pulmonary dyspnea group and normal control group (q = 17.0676, P <0.01; q = 15.1143, P <0.01). PVD-FAI was closely associated with PCWP (r = 0.388, P = 0.000). Multivariate logistic regression analysis showed that chest X-ray PVDF was a predictor of CHF (P = 0.000, odds ratio 28.103). The area under the curve was 95.24% (95% confidence interval, 91.73% -98.85%) for determining pulmonary dyspnea or heart failure by PVDFAI. The best cutoff value of PVDFAI for judging left ventricular dysfunction was 2.5 mm. The sensitivity, specificity and accuracy of PVDFAI for diagnosing left ventricular dysfunction were 97.17%, 93.26% and 95.38% respectively. Conclusions The diameter of the first anterior intercostal pulmonary vein can be used to identify the presence of pulmonary hypertension and is valuable for the diagnosis of heart failure.