BNP和NT—proBNP在鉴别舒张性心力衰竭中的应用研究

Application of BNP and NT-proBNP in diagnosis of diastolic heart failure

目的研究慢性心力衰竭患者血浆BNP及NT—proBNP浓度的变化，评价BNP及NT-proBNP对鉴别舒张性心力衰竭的作用。方法对2004--2006年在解放军总医院临床诊断为舒张性心力衰竭129例患者和收缩性心力衰竭109例患者进行血浆BNP和NT—proBNP浓度测定，通过与对照组（77名）的比较，分析血浆BNP和NT-proBNP升高的相关因素，并用ROC曲线评价BNP和NT-proBNP对鉴别舒张性心力衰竭的作用。结果和对照组（血浆BNP和NT—proBNP浓度中位数分别为58．51ng／L和69．80ng／L）比较，慢性心力衰竭患者血浆BNP和NT-proBNP浓度明显升高，其中舒张性心力衰竭和收缩性心力衰竭组患者血浆BNP浓度中位数分别为254．16ng／L和923．08ng／L，NT—proBNP浓度中位数分别为899ng／L和3695ng／L，血浆BNP和NT—proBNP升高的程度与NYHA心功能分级显著相关（p值分别为0．201和0．323，P值均〈0．001）。BNP和NT-proBNP诊断慢性心力衰竭的曲线下面积分别为0．906（95％可信区间：0．865—0．946）和0．956（95％可信区间：0．932～0．980），BNP鉴别舒张性心力衰竭和收缩性心力衰竭的曲线下面积为0．781（95％可信区间：0．710～0．852），NT—proBNP鉴别舒张性心力衰竭和收缩性心力衰竭的曲线下面积为0．757（95％可信区间：0．686—0．828）。结论慢性心力衰竭患者的血浆BNP和NT—proBNP水平均明显升高，升高的程度和NYHA心功能分级相关，两者是诊断慢性心力衰竭的良好指标，但对鉴别舒张性心力衰竭的作用不大。

Objective To investigate the plasma levels of BNP and NT-proBNP in patients with chronic heart failure （ CHF）, and to evaluate the capabilities of them to discriminate diastolic heart failure （DHF） from systolic heart failure （SHF）. Methods One hundred and twenty nine patients with DHF and 109 patients with SHF were subjected to plasma BNP and NT-proBNP determination in Beijing PLA general hospital from the year of 2004 to 2006. The factors influencing the levels of BNP and NT-proBNP were analyzed through the comparison with results from 77 age and gender-matched healthy volunteers. ROC was used to evaluate the roles of BNP and NT-proBNP in the diagnosis of Diastolic heart failure. Results Compared with the controls, plasma BNP and NT-proBNP concentrations were upregulated significantly in DHF and SHF patients, with the median of 254. 16 ng/L and 899 ng/L in DHF and 923.08 ng/L and 3 695 ng/L in SHF respectively. The increase extent of BNP and NT-proBNP was exclusively related to NYHA classification of heart fimction（β = 0. 201 and 0. 323 respectively, P 〈 0. 001 ）. BNP and NT-proBNP showed AUCs of 0. 906 （ 95% CI： 0. 865-0. 946 ） and 0. 956 （ 95% CI： 0. 932-0. 980 ） respectively for diagnosis of CHF. BNP and NT-proBNP showed AUCs of 0. 781 （ 95% CI： 0. 710-0. 815 ） and 0. 757 （ 95% CI： 0. 686- 0. 828）respectively for diagnosis of DHF and SHF. Conclusions BNP and NT-proBNP are upregnlated significantly in CHF patients and associated with the NYHA classification significantly and exclusively. BNP and NT-proBNP can be used to identify CHF rather than DHF.