呼吸困难患者快速检测脑钠素的意义

Significance of rapid measurement of brain natriuretic peptide in patients with dyspnea

目的评价呼吸困难患者床旁快速测定血浆脑钠素(BNP)浓度对心力衰竭(HF)诊断的意义.方法随机选择2002年3月～2003年3月至我科就诊的呼吸困难患者49例,其中男26例,女23例,年龄46～93岁,平均为76岁.按Framingham标准分为两组,第一组(20例)为无HF患者,第二组(29例)为HF患者,采用心力衰竭/心肌梗死诊断仪[Triage(r)meter plus诊断仪]进行床旁快速检测血浆BNP浓度;其中37例(第一组13例,第二组24例)行二维超声心动图检查测定左室射血分数(LVEF).结果第二组血浆BNP浓度为(770.14±157.80)pg/ml,明显高于第一组的(44.98±7.65)pg/ml(P＜0.01);第二组的LVEF值为54.2%±3.01%,明显低于第一组的67.62%±1.72%(P＜0.05).以血浆BNP浓度＞80pg/ml为标准诊断HF时,其敏感性和特异性分别为89.66%和90.00%;以LVEF值＜50%为标准诊断HF时,其敏感性和特异性分别为41.60%和100.00%.结论采用心力衰竭/心肌梗死诊断仪对呼吸困难患者进行床旁血浆BNP浓度检测,对诊断HF是一种特异性和敏感性均较高的简便而快速、有效的方法.

Objective To evaluate the rapid measurement of brain natriuretic peptide (BNP) in diagnosing heart failure of patients with dyspnea. Methods 49 patients with dyspnea admitted from March 2002 to March 2003 in ED of Zhongshan Hospital were divided into 2 groups according to Framingham standard, including first group (n=20) of no heart failure (HF) and second group (n=29) with HF. In all 49 cases, the plasma concentrations of BNP were rapidly detected by Triage(r)meter plus. In 37 of 49 cases, the left ventricular ejection fraction (LVEF) by echocardiography was recorded. Results The concentration of BNP in group 2 [(770.14 ±157.80) pg/ml] were significantly higher than those in group 1 [(44.98±7.65) pg/ml, P<0.01]. LVEFs in group 2 (54.2%± 3.01%) were significantly less than those in group 2 (67.62%±1.72%)(P<0.05). The sensitivities of BNP (>80 pg/ml) and LVEF (<50%) in diagnosis of HF were 89.66% and 41.60% respectively, the specificities of BNP and LVEF were 90.00% and 100.00% respectively. Conclusion Rapid measureing concentration of plasma BNP by Triage(r)meter is an effective method for diagnosing HF in patients with dyspnea.