心不全の疑いのあるプライマリケア患者の体検査と追加検査の診断価値
Johannes C Kelder1, Maarten J Cramer, Jan van Wijngaarden
1Julius Center for Health Sciences and Primary Care, Room 6.101, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands, PO Box 85500, 3508 GA Utrecht, The Netherlands. hans.kelder@gmail.com
Circulation
|November 23, 2011
まとめ
初等医療における新規発症した心不全の診断は困難です. 患者の病歴,身体検査結果,およびN-ターミナルプロB型ナトリウレチンペプチド (NT-proBNP) 測定を組み合わせることで,診断の正確性が著しく向上します.
科学分野:
- 心臓病学 心臓病学
- プライマリーケア医療 プライマリーケア医療
- 診断精度に関する研究 診断精度に関する研究
背景:
- 非急性心不全の早期診断は,効果的な治療と疾患の進行を遅らせるために重要です.
- 初等医療施設での新規発症した心不全の診断は,重大な課題を提示しています.
研究 の 目的:
- 疑わしい心不全の初等保健室患者の臨床史と身体検査要素の診断の貢献度を定量化するために.
- N-ターミナルプロB型ナトリウレチンペプチド (NT-proBNP) の測定による診断上の付加価値を評価する.
- 心不全の確率のための簡素化された診断ルールを導き出し,検証する.
主な方法:
- 新発性心不全を疑われる721人の患者を対象とした横断的診断精度研究.
- 標準化された検査には,胸部X線,スピロメトリー,心電図,NT-proBNP測定,心声エコーが含まれる.
- 心不全の診断は,初期および6ヶ月のフォローアップデータを用いたアウトカムパネルによって決定され,バイオマーカーの結果に盲目されました.
主要な成果:
- 721人の患者のうち207人 (28.7%) が心不全を発症した.
- 病歴 (年齢,冠動脈疾患,ループ利尿剤の使用) と身体検査結果 (脈拍/規則性,アペックスビート,ラレス,ムーム,動脈圧) の組み合わせにより,c統計値0.83.8を達成しました.
- NT-proBNP測定により,診断の精度が0.86のc統計値まで向上し,再分類が69%改善した (P<0.0001).
- 外部検証データセットでは,高C統計値0.95と0.88.8を示した.
結論:
- 歴史と身体検査の要素は,初等医療における心不全の診断に貴重な情報を提供します.
- NT-proBNP測定は,最も重要な追加の診断価値を提供します.
- 誘導された診断ルールは,暗示的な症状を持つ患者の心不全の確率を定量化するのに役立ちます.
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