床边即时脑利钠肽检测对呼吸困难的诊断价值

Diagnoses value of bedside measurement of plasma brain natriuretic in patients with dyspnea

目的 探讨床边即时检测脑利钠肽(BNP)对呼吸困难患者的鉴别诊断价值。方法荧光免疫法测定103例呼吸困难患者血浆BNP,心脏超声和漂浮导管法分别测定心脏左室射血分数和肺毛细血管楔压。结果 (1)心力衰竭(心衰)患者血浆BNP水平明显高于非心衰组患者[(716±86)ng／L与(46±7)ng／L,P<0.01];(2)如以100 ng／L为正常参考值,BNP诊断心衰的敏感性为96.8％,特异性为97.6％,排除心衰的阴性预测价值为97.1％;(3)心衰患者BNP水平与肺毛细血管楔压呈正相关(r=0.43,P<0.01),与左室射血分数呈负相关(r=-0.56,P<0.01)。结论 床边即时检测BNP诊断心衰敏感而且特异,可作为急诊呼吸困难鉴别诊断的一个观察指标。

Objective To investigate differential diagnoses value of ultra-rapid bedside measurement of brain natriuretic peptide (BNP) in patients with dyspnea. Methods Plasma BNP concentration was measured with immunofluorescence assay in 103 patients with dyspnea. Left ventricular ejection fraction (LVEF) and pulmonary capillary wedge pressure (PCWP) were determined by echocardiography and Swan-Ganz catheter in these patients on the same time, respectively. Results (1) Plasma BNP levels in the patients with heart failure were higher than those in the non-heart failure patients [(716±86) ng/L vs. (46±7) ng/L,P <0. 01 ]. (2)The sensitivity, specificity and negative predictive values of plasma BNP levels ≥100 ng/L for predicting heart failure were 96. 8% , 97. 6% and 97. 1 % , respectively. (3) Plasma BNP levels were positively related to PCWP, and negatively related to LVEF (r = -0.56, both P < 0. 01). Conclusion Bedside BNP assay seems sensitive and specific for diagnosing heart failure, and useful in evaluating dyspnea in emergency care.