基于心肺超声特征的预测模型鉴别慢性肾病患者心源性与非心源性呼吸困难
本研究为单中心回顾性观察研究，纳入慢性肾脏病3-5期患者，分为训练组215例和验证组56例，构建了结合超声心动图与肺超声参数的多变量 logistic 回归诊断模型及简化 β 加权评分系统，用于鉴别心源性肺水肿与非心源性呼吸困难。模型在训练组和验证组的 AUC 分别为 0.9703 和 0.8910，β 加权评分系统（切点 42.99 分）的 AUC 分别为 0.968 和 0.888，显示出较高的预测准确性。
要点
- 双侧对称 B 线、双侧连续 B 线、下腔静脉增宽及 E/e' 升高提示心源性肺水肿。
- 不规则胸膜线、肺实变区更支持非心源性呼吸困难。
- β 加权评分系统切点 42.99 分，验证组 AUC 0.888，可作为辅助鉴别工具。
英文原文（摘要）· 点击展开
OBJECTIVES: Lung ultrasound (LUS) quantifying B-lines is valuable to assess fluid status during hemodialysis. However, B-lines may indicate not only cardiogenic pulmonary edema (CPE) but also non-cardiogenic pulmonary diseases, such as pneumonia or interstitial lung disease, posing challenges to guiding fluid therapy decisions. We developed a combined cardiac-LUS diagnostic model to differentiate these etiologies, aiming to prevent misdiagnosis and optimize treatment.
METHODS: This retrospective observational study enrolled chronic kidney disease (CKD) stage 3-5 patients divided into training and validation cohorts. Participants were classified into CPE group or non-cardiogenic dyspnea (NCD) group. Multivariable logistic regression identified discriminative echocardiographic and LUS parameters to build a diagnostic model. Predictive performance was assessed using receiver operator characteristic (ROC), calibration and decision curve analysis. A simplified β-weighted scoring system was developed and evaluated.
RESULTS: This retrospective study analyzed 215 training and 56 validation participants. Multivariable regression identified E/e' (OR 1.180, 95% CI 1.067-1.304, p = .001), inferior vena cava diameter (OR 1.240, 95% CI 1.023-1.503, p = .029), bilateral symmetric B-pattern (OR 9.720, 95% CI 2.707-34.899, p < .001), bilateral continuous B-pattern (OR 13.777, 95% CI 3.666-51.770, p < .001), ≥1 irregular pleural line region (OR 0.078, 95% CI 0.018-0.326, p < .001), ≥1 consolidation region (OR 0.039, 95% CI 0.008-0.196, p < .001), ≥1 pleural effusion region (OR 4.732, 95% CI 1.148-19.510, p = .032) as independent CPE predictors. The nomogram showed good discrimination, with area under the curve (AUC) of 0.9703 (training) and 0.8910 (validation). The β-weighted scoring system (cut-off as 42.99 scores) showed an AUC of 0.968 (training) and 0.888 (validation).
CONCLUSION: The nomogram model demonstrated that the ultrasound parameters and β-weighted scoring system possess reliable clinical application value and high predictive accuracy.
引用
- Zhao H, Zhang Z, Long L, et al. A Predictive Model Based on Cardio and Lung Ultrasound Features for Differential Diagnosis of Cardiogenic and Non-cardiogenic Dyspnea in Patients With Chronic Kidney Disease: A Single-Center Observational Study. J Ultrasound Med. 2026. PMID: 42200685. doi:10.1002/jum.70317
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。