超声心动图联合血清cTnI、ESM-1在慢性肺源性心脏病患者病情评估中的应用价值-东南大学学报医学版

超声心动图联合血清cTnI、ESM-1在慢性肺源性心脏病患者病情评估中的应用价值

单位：1. 廊坊市中医医院超声科, 河北廊坊 065000;
2. 廊坊市中医医院呼吸与危重症科, 河北廊坊 065000

分类号：R541.5

出版年·卷·期（页码）：2025·44·第二期（299-305）

摘要：

目的:分析超声心动图联合血清肌钙蛋白I(cTnI)、内皮细胞特异性分子-1(ESM-1)在慢性肺源性心脏病患者病情评估中的应用价值。方法:选取2021年3月至2024年1月本院收治的98例慢性肺源性心脏病患者为研究对象,根据患者病情程度分为代偿组(n=46)和失代偿组(n=52)。ELISA检测患者血清cTnI、ESM-1水平,收集分析患者一般资料,并进行超声心动图检查;Pearson法分析cTnI、ESM-1与超声心动图指标的相关性。绘制受试者工作特征(ROC)曲线,分析cTnI、ESM-1、超声心动图对慢性肺源性心脏病患者病情的诊断价值。结果:与代偿组相比,失代偿组患者血清cTnI水平、ESM-1水平、最大肺动脉血流速度、平均肺动脉血流加速度、右房内径、右室内径、右心室流出道内径、肺动脉内径、三尖瓣最大反流速度以及肺动脉收缩压(PASP)均显著升高(P＜0.05),三尖瓣舒张早期血流速度与右房室瓣舒张晚期A波峰值的比值(E/A)显著降低(P＜0.05)。cTnI、ESM-1与最大肺动脉血流速度、平均肺动脉血流加速度、右房内径、右室内径、右心室流出道内径、肺动脉内径、三尖瓣最大反流速度以及PASP呈正相关(P＜0.05),与E/A呈负相关(P＜0.05)。cTnI、ESM-1、超声心动图及三者联合评估患者病情程度的AUC分别为0.862、0.831、0.781、0.920,三者联合评估病情程度的AUC显著高于cTnI(Z=2.080,P=0.038)、ESM-1(Z=2.824,P=0.005)、超声心动图(Z=33.659,P=0.000 3)单独评估。结论:慢性肺源性心脏病失代偿患者血清cTnI、ESM-1水平升高,与超声心动图具有一定相关性,且三者联合对患者病情评估具有一定辅助诊断价值。

Objective: To study the application value of echocardiography combined with serum cardiac troponin I(cTnI) and endothelial cell specific molecule-1(ESM-1) in the condition assessment of chronic pulmonary heart disease patients. Methods: Ninety-eight patients with chronic pulmonary heart disease admitted to our hospital from March 2021 to January 2024 were regarded as the observation group. They were separated into compensatory group(n=46) and decompensated group(n=52) based on the severity of their condition. ELISA was applied to detect serum cTnI and ESM-1 levels in patients, and general clinical data were collected and analyzed. Pearson method was applied to analyze the correlation between cTnI, ESM-1 and echocardiographic indicators. Receiver operating characteristic(ROC) curve was plotted to analyze the diagnostic value of cTnI, ESM-1 and echocardiography in patients with chronic pulmonary heart disease. Results: Compared with the compensatory group, the levels of serum cTnI and ESM-1, maximum pulmonary artery blood flow velocity, mean pulmonary artery blood flow acceleration, right atrial internal diameter, right intraventricular internal diameter, right ventricular outflow tract internal diameter, pulmonary artery internal diameter, tricuspid maximal regurgitant velocity, and pulmonary artery systolic pressure(PASP) in the decompensated group were obviously increased(P<0.05). The ratio of early tricuspid valve diastolic blood flow velocity to late right atrioventricular valve diastolic A-wave peak(E/A) obviously decreased(P<0.05). cTnI and ESM-1 were positively correlated with maximum pulmonary artery blood flow velocity, average pulmonary artery blood flow acceleration, right atrial internal diameter, right intraventricular internal diameter, right ventricular outflow tract internal diameter, pulmonary artery internal diameter, tricuspid maximal regurgitant velocity, and PASP(P<0.05), and negatively correlated with E/A(P<0.05). The AUCs of cTnI, ESM-1, echocardiography and the combination of the three for diagnosing the extent of the patient's condition were 0.862, 0.831, 0.781 and 0.920, respectively, and the AUC for diagnosing the extent of the condition with the combination of the three was significantly higher than that for cTnI(Z=2.080,P=0.038), ESM-1(Z=2.824,P=0.005) and echocardiography(Z=33.659,P=0.000 3) alone diagnosis(P<0.05). Conclusion: The elevated levels of serum cTnI and ESM-1 in patients with decompensated chronic pulmonary heart disease are correlated with echocardiography, and the combination of the three has certain auxiliary diagnostic value for evaluating the patient's condition.

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