检测B型利钠肽对急诊呼吸困难的鉴别诊断意义

The diagnostic value of B-type natriuretic peptide measurement in patients with acute dyspnea.

目的:探讨B型利钠肽(Btypenatriureticpeptide,BNP)用于甄别急诊呼吸困难中的充血性心力衰竭(congestiveheartfailure,CHF)的早期诊断意义。方法:130例急诊呼吸困难患者,根据临床资料及左心室射血分数(leftventricularejectionfraction,LVEF)分为CHF组(78例)和非CHF组(52例)。采用干式快速免疫荧光法定量分析检测血液中的BNP浓度。结果:CHF组BNP浓度为(732±53)ng/L,显著高于非CHF组的(71±34)ng/L(P<0.01);以BNP100ng/L作为阈值区分呼吸困难是否为CHF所致,其敏感度、特异度、准确性分别为92%、96%、93%;在CHF组中,BNP浓度在不同心功能级别之间差异有统计学意义(P<0.01),随心功能不全加重而升高。猝死者的BNP值高于存活者。结论:BNP水平对于CHF的诊断具有较高的灵敏度、特异度和准确性。对于鉴别呼吸困难是否为心源性具有重要意义。

Objective:To investigate the diagnostic value of B-type natriuretic peptide(BNP)in differentiating congestive heart failure(CHF)from lung disease in patients presenting with acute dyspnea. Methods:One hundred and thirty patients with acute dyspnea were divided into CHF group and non-CHF group according to the left ventricular ejection fraction(LVEF).Blood BNP was measured by rapid fluorescence immunoassay. Results:The level of BNP in CHF group [(732±53)ng/L] was significantly higher than that in non-CHF group[(71±34)ng/L,P<0.01]. Using 100 ng/L of BNP as the diagnostic threshold for CHF, the sensitivity, specificity and accuracy of diagnosis was 92%, 96% and 93% respectively. There were significant differences in BNP level among different classifications of CHF (P<0.01) and the blood BNP level was positively correlated with heart failure. BNP level in sudden death patients was significantly higher than that of the survivor. Conclusion: BNP level has relatively high sensitivity, specificity and accuracy for the diagnosis of CHF and is valuable for the differential diagnosis of CHF in patients presenting with dyspnea.