经胸肺超声彗尾征鉴别诊断心源性呼吸困难

目的 探讨经胸肺超声彗尾征在鉴别心源性与慢性阻塞性肺疾病(COPD)性呼吸困难的价值.方法 对比分析40例充血性心力衰竭患者(CHF组)、22例COPD患者(COPD组)和10例健康志愿者(NORM组)三组间、CHF组治疗前后彗尾数中位数,以及诊断肺水肿阳性率间的差异.以彗尾数＞5诊断肺水肿,通过ROC曲线判断彗尾数的鉴别价值.结果 CHF组治疗前彗尾数中位数(25％～75％分位数)及诊断肺水肿阳性率分别为18(11～25)条、90％,与COPD组的2(0～8)条、27％和NORM组的2(0～5)条、10％比较差异均有统计学意义(P＜0.01)；CHF组治疗后彗尾数中位数(25％～75％分位数)及阳性率分别为5(2～11)条、38％,与治疗前比较差异有统计学意义(P＜0.01).ROC曲线下面积为0.928(P＜0.01),彗尾数＞5条诊断充血性心力衰竭的敏感性、特异性分别为90％、78％.结论 肺超声彗尾征对鉴别心源性与COPD性呼吸困难有较高的敏感性和特异性,可在临床推广应用.

Value of transthoracic lung ultrasound comet-tail in differential diagnosis of cardiogenic dyspnea

Objective To explore the value of transthoracic lung ultrasound(LUS)comet-tail in the differential diagnosis between cardiogenic dyspnea and chronic obstructive pulmonary disease(COPD)dyspnea. Method Forty patients with CHF (CHF group),22 patients with COPD(COPD group)and 10 healthy volunteers(NORM group)were enrolled in the study. The comet-tail counts(B-lines)on the anterior and lateral chest were detected by LUS within 24 h after admission. The B-lines>5 was diagnosed as pulmonary edema. The differences of the B-lines among the three groups,medianins before and after treatment in CHF group and diagnostic positive rates of pulmonary edema were compared. The ROC curve was used to decide the value of B-lines in differential diagnosis between cardiogenic dyspnea and COPD dyspnea. Results The medianins of B -lines before treatment and diagnostic positive rates of pulmonary edema in CHF group,COPD group and NORM group were 18 (11~25) and 90%,2(0~8)and 27%,2(0~5)and 10%,respectively. There were significant differences among the three groups(P<0.01). The medianin of B-lines after treatment and diagnostic positive rate of pulmonary edema in CHF group were 5 (2~11) and 38%, respectively.There was a significant difference compared with before treatment (P<0.01).The area under the ROC was 0.928 (P<0.01). The sensitivity and specificity of B-lines >5 diagnosed as CHF were 90% and 78% ,respectively. Conclusion The B- lines detected by LUS have great sensitivity and specificity in the differential diagnosis between CHF and COPD,and it should be promoted in clinical practice.