左房应变联合中性粒细胞/淋巴细胞比值在尿毒症患者HFpEF中的诊断价值

Diagnostic Value of Left Atrial Strain Combined with Neutrophil-to-Lymphocyte Ratio for HFpEF in Patients with Uremia

摘要: 目的：在传统超声指标诊断射血分数保留的心力衰竭(HFpEF)存在局限的情况下，探讨左房储存期应变(LASr)、中性粒细胞/淋巴细胞比值(NLR)及二者联合对尿毒症患者HFpEF的诊断价值。方法：纳入96例尿毒症患者，分为A组(尿毒症伴HFpEF患者) 67例和B组(尿毒症不伴心衰患者) 29例。应用二维斑点追踪技术获取左房应变参数，计算中性粒细胞/淋巴细胞比值(NLR)、全身免疫炎症指数(SII)等炎症指标。采用二元Logistic回归分析独立影响因素，并构建联合预测模型，运用受试者工作特征(ROC)曲线评估其诊断效能。结果：二元Logistic回归显示，LASr (OR = 0.796, P < 0.05)和NLR (OR = 1.735, P < 0.05)均为评估尿毒症患者合并HFpEF的独立影响因素。LASr、NLR及二者联合诊断尿毒症患者HFpEF的曲线下面积分别为0.759、0.755和0.845，联合模型的敏感度高达92.5%，特异度为65.5%。结论：在传统超声指标诊断效能不佳的尿毒症人群中，LASr和NLR参数联合显著提升了诊断效能，尤其表现出高敏感度，有助于HFpEF高危人群的早期筛查，但较低的特异度提示临床应用时需注意假阳性风险，该模型更适合作为辅助识别工具而非确诊手段。

Abstract: Objective: To investigate the diagnostic value of left atrial reservoir strain (LASr), neutrophil-to-lymphocyte ratio (NLR), and their combination for heart failure with preserved ejection fraction (HFpEF) in uremic patients, considering the limitations of conventional echocardiographic indices in diagnosing HFpEF. Methods: A total of 96 uremic patients were enrolled and divided into Group A (uremic patients with HFpEF, n = 67) and Group B (uremic patients without heart failure, n = 29). Left atrial strain parameters were obtained using two-dimensional speckle-tracking echocardiography. Inflammatory indices including NLR and systemic immune-inflammation index (SII) were calculated. Binary logistic regression analysis was performed to identify independent influencing factors, and a combined predictive model was constructed. The diagnostic performance was assessed using receiver operating characteristic (ROC) curves. Results: Binary logistic regression analysis revealed that both LASr (OR = 0.796, P < 0.05) and NLR (OR = 1.735, P < 0.05) were independent predictors of HFpEF in uremic patients. The areas under the ROC curve for LASr, NLR, and their combination in diagnosing HFpEF were 0.759, 0.755, and 0.845, respectively. The combined model achieved a sensitivity of 92.5% and a specificity of 65.5%. Conclusion: In the uremic population, where conventional echocardiographic indices demonstrate limited diagnostic performance, the combination of LASr and NLR significantly improves diagnostic efficacy, particularly with high sensitivity, facilitating early screening for HFpEF in high‑risk patients. However, the relatively low specificity warrants caution regarding false-positive results in clinical practice, suggesting that the model is more suitable as an adjunctive identification tool rather than a confirmatory diagnostic approach.