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目的 通过分析就诊于急诊的急性呼吸困难患者临床资料,确立急性心力衰竭(acute heart failure AHF)的早期诊断预测因子.方法 前瞻性入选因急性呼吸困难就诊于急诊的患者,收集患者临床资料包括:病史、体格检查、心电图、心肌肌钙蛋白I(cardiac troponin I,cTnI)、B型利尿钠肽(B-Type natriuretic peptide,BNP)及血气分析结果.由急诊科主治医师根据病情做出相应的处置并继续完善胸部X线、血常规、血生化等检查.12~24 h后由心内科主治医师根据各组患者的临床资料结合患者对于针对治疗的反应,做出AHF的诊断.比较AHF组和非AHF组临床资料的差异,采用Logistic多元回归模型分析AHF急诊诊断预测因子.结果 2015年7月~2016年9月,共有719例急性呼吸困难患者纳入本研究,其中355例(49.4%)患者诊断为AHF,AHF组342(96.3%)例住院或急诊留观.与非AHF组相比,既往高血压(P<0.01)、糖尿病(P<0.05)、心肌梗死(P<0.01)和心力衰竭病史(P<0.01)更多见于AHF组患者.临床表现方面,AHF组出现胸痛者较多(P<0.05).心脏杂音(P<0.05)和双肺啰音(P<0.05)较多见于AHF组.BNP增高(P<0.01)、TNI异常(P<0.01)和快速房颤(P<0.01)更多见于AHF组.AHF及非AHF组分别有247及165例完成急诊超声心动图检查,左室射血分数(left ventricular ejection fraction LVEF)降低AHF组亦更为多见(P<0.01).多变量logistic回归分析结果显示,既往心肌梗死、慢性心衰、来诊时双肺啰音、快速房颤和BNP水平增高是AHF诊断的独立预测因子.结论 既往心肌梗死、慢性心衰病史、双肺啰音、快速房颤和BNP水平增高是AHF诊断的独立预测因子“,”Objective We performed the study to investigate predictors for early diagnosis of acute heart failure (AHF) in the emergency department. Methods We prospectively recruited patients who presented to the emergency department with acute dyspnea between May 2015 and September 2016. Demographic information and clinical features were retrieved after patient admission. Patients received laboratory tests, electrocardiogram examination, and imaging examinations. Diagnosis of AHF was made by cardiology attending physicians based on clinical data. Clinical characteristics were compared between the AHF patients and non-AHF patients. Multivariate logistic regression analysis was performed to determine the predictors for the diagnosis of AHF.Results Of the 719 patients included in the study, 355 (49.4%) were diagnosed with AHF. Compared with non-AHF patients, the ratio of hypertension(P<0.01), diabetes(P<0.05), old myocardial infarction(P<0.01) and chronic heart failure(P<0.01)were significantly higher in AHF patients. Moreover, chest pain(P<0.05), heart murmur(P<0.05), both lung rales(P<0.05 ), atrial fibrillation with rapid ventricular rate(P<0.01), elevated B-type natriuretic peptide (BNP) level(P<0.01), and elevated cardiac troponin I(cTNI) level(P<0.01)were more frequently presented in AHF patients (P<0.05 for all). Echocardiogram examinations were performed in 247 AHF patients, and 165 non-AHF patients. Patients with left ventricular ejection fraction(LVEF) less than 40%appeared to be more common in AHF group, compared with non-AHF group (P<0.05). Logistic regression analysis showed that old myocardial infarction, chronic heart failure, both lungs rales, atrial fibrillation with rapid ventricular rate, and elevated BNP level were independent predictors for AHF. Conclusion For patients who presented to the emergency department with acute dyspnea, presence of comorbidities (old myocardial infarction, and chronic heart failure history), both lungs rales, atrial fibrillation with rapid ventricular rate, and elevated BNP level seem to be independent predictors for the diagnosis of AHF.