在怀疑心力衰竭的初级保健患者体检和额外测试的诊断价值
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
概括
在初级保健中诊断新发性心力衰竭是具有挑战性的. 结合患者病史,体检结果和N-终端亲B型性尿素 (NT-proBNP) 测量,可显著提高诊断准确度.
科学领域:
- 心脏病学 心脏病学
- 初级医疗保健医学 一级医疗保健医学
- 诊断准确性研究 诊断准确性研究
背景情况:
- 早期诊断非急性心力衰竭对于有效治疗和减缓疾病进展至关重要.
- 在初级保健机构中诊断新发性心力衰竭存在重大挑战.
研究的目的:
- 量化临床病史和体检元素在怀疑心力衰竭的初级护理门诊患者的诊断贡献.
- 评估测量N-终端亲B型性尿素 (NT-proBNP) 的诊断附加值.
- 为了推导和验证心力衰竭概率的简化诊断规则.
主要方法:
- 一项涉及721名怀疑患有新发性心力衰竭的患者的横截式诊断准确性研究.
- 标准化工作包括胸部X射线,精神测量,心电图,NT-proBNP测量和心声回声.
- 心力衰竭的诊断是通过使用初始和6个月随访数据的结果小组来确定的,对生物标志物结果视而不见.
主要成果:
- 在721名患者中,有207名 (28.7%) 患有心力衰竭.
- 病史 (年龄,冠状动脉疾病,循环利尿剂使用) 和体检结果 (脉率/规律性,顶点节拍,拉尔斯,声,静脉压力) 的结合,实现了0.83.8的c统计值.
- NT-proBNP测量提高了诊断准确度,达到0.86的c统计值,净重新分类改善69% (P<0.0001).
- 外部验证数据集显示高c-统计值为0.95和0.88.
结论:
- 病史和体检的要素为初级保健中心力衰竭提供了有价值的诊断信息.
- 测量NT-proBNP提供了最重要的额外诊断价值.
- 一个导出的诊断规则可以帮助量化心力衰竭的概率的患者有暗示性症状.
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