N末端脑型钠尿肽定量检测在心力衰竭诊断中的价值

Clinical application and evaluation of N-terminal pro-Brain natriuretic peptide quantitative detection in heart failure laboratory diagnosis

目的评价血清N末端脑型钠尿肽(NTproBNP)定量检测对不同程度心力衰竭患者的实验室诊断应用价值和血清NTproBNP水平与心功能间的相关性分析。方法采用电化学发光检测仪Elecsys2010定量检测不同心功状态的心力衰竭患者血清NTproBNP水平。结果血清NTproBNP的诊断性实验受试者工作特征曲线的曲线下面积为0.880(P<0.01),155pg/ml为界值时,其敏感性,特异性均为81%,阳性似然比为4.25,当NTproBNP水平>350pg/ml时,阳性似然比可增至14.32。心衰患者血清NTproBNP水平明显增高,与心功能正常的疾病对照组比较其差异有统计学意义(P<0.05),血清NTproBNP水平随着心力衰竭程度加重呈指数增加,其秩相关性系数为0.859(P<0.01)。采用相同的心功分级标准,但中国汉族和欧洲心力衰竭患者不同心功分级时血清NTproBNP水平的变化趋势不同。结论血清NTproBNP定量检测是目前用于评价心衰患者心功能状态最佳实验室指标。NTproBNP实验室诊断标准的确立必须以本地区本实验室为基础。

Objective To evaluate the diagnostic value of N-terminal pro-Brain natriuretic peptide （NT-proBNP） quantitative detection for heart failure, and analyze the relationship between serum NT- proBNP and heart function. Methods To apply electrochemiluminescence immunoassay on Elecsys 2010 to quantitatively detect serum NT-proBNP in heart failure patients with different heart destroy. Results Receiver operator characteristic curve （ ROC ） shows that area under curve （ AUC ） is 0. 880 （ P 〈 0. 01 ） ; and 155 pg/ ml is the best cutoff for diagnosing heart failure with 81% sensitivity and specificity, and positive likelihood ratio （PLR） is 4. 25; when NT-proBNP is more than 350 pg/ml, PLR is increased to 14. 32. NT- proBNP significantly increases in heart failure patients ,and has significance compared with disease control group with normal heart function, P 〈 0.05. With the increasing of heart destroy, NT-proBNP increases in exponent, and their rank correlation coefficient is 0. 859 （P 〈 0. 01 ）. On the same criteria of heart function classification, there is difference in serum NT-proBNP between European and han-people Chinese patients. Conclusion Quantitative detection of NT-proBNP is now the best laboratory test for evaluating heart function of patients with heart failure. The laboratory criteria of serum NT-proBNP to diagnose heart failure must be defined with characteristic of laboratories and districts.