血清N末端B型钠尿肽原在心功能评价及慢性充血性心力衰竭诊断中的初步应用

Value of serum NT-proBNP in the evaluation of cardiac function and diagnosis of chronic heart failure

目的 通过观察血清N末端B型钠尿肽原 (NT proBNP)浓度与心功能分级 (NYHA分级 )、左室射血分数 (LVEF)等临床指标之间的关系 ,研究NT proBNP对心功能的评价作用及其在诊断慢性充血性心力衰竭中的初步应用。方法 选择我院 2 0 0 3年 10月至 2 0 0 4年 4月门诊及住院慢性心衰患者 111例 ,正常对照组 39名。采用电化学发光法测定血清NT proBNP浓度 ,超声心动测定受试者LVEF等指标。依据美国纽约心脏病协会 (NYHA)分级方案对心衰患者进行心功能分级。心衰诊断以临床医生依据病史、症状、体征、客观检查等作出的综合判断为金标准。结果 心衰组NT proBNP中位数 (316 5 pg/ml)显著高于对照组 (5 6 2 1pg/ml) (P <0 0 1)。NYHA分级与NT proBNP呈显著正相关 (r =0 818,P <0 0 1) ,LVEF与NT proBNP呈显著负相关 (r =- 0 6 36 ,P<0 0 1)。受试者工作特征 (receiveroperatingcharacteristics,ROC)曲线分析 ,NT proBNP诊断心衰和左室收缩功能不全的诊断界值 (cutoff值 )分别为 12 7 2 pg/ml和 6 6 7pg/ml,此时诊断心衰和左室收缩功能不全的灵敏度和特异度分别为 73%、10 0 %和 91 7%、85 7% ;诊断心衰的阳性预测值为 10 0% ,阴性预测值为 5 7%。结论 NT proBNP可以客观准确评价心功能 ,对心衰及左室收缩?

Objective To investigate the value of serum NT proBNP in the evaluation of cardiac function and the diagnosis of chronic heart failure Methods 150 subjects aged 60 years or older were selected, including 39 healthy controls and 111 patients with chronic heart failure The concentration of serum NT proBNP was determined by an automated electrochemiluminescence immunoassay on Roche Elecsys 2010 Left ventricular ejection fraction (LVEF) was measured by the modified Simpson′s equation with echocardiography The diagnosis of clinical physician was considered to be the golden standard for heart failure The relationships between the concentration of serum NT proBNP and New York Heart Association (NYHA) classification, and LVEF were analyzed Diagnostic utilities were tested by ROC analyses Results Serum NT proBNP levels are significantly higher in heart failure patients compared with healthy controls [316 5(18 91 25 488)pg/ml vs 56 21 (16 31 127 2) pg/ml, P < 0 01] NT proBNP showed positive correlation with NYHA classification ( r = 0 818, P < 0 01) and negative correlation with LVEF ( r = -0 636, P < 0 01) When cutoff value was 127 2 pg/ml for heart failure and 667 pg/ml for left ventricular systolic dysfunction, sensitivity and specificity were 73%,100% and 91 7%,85 7% , respectively With cutoff value of 127 2 pg/ml, positive predictive value (PPV) and negative predictive value (NPV) for NT proBNP were 100 % and 57 % to detect heart failure Conclusion NT proBNP is a valuable biomarker for the evaluation of cardiac function and the diagnosis of heart failure as well as left ventricular systolic dysfunction for its high sensitivity and specificity