B型钠尿肽对急性呼吸困难的鉴别诊断意义

Diagnostic value of B-type natriuretic peptide in pati ents with acute dyspnea

目的探讨B型钠尿肽(Btypenatriureticpeptide)对充血性心力衰竭患者急性呼吸困难的鉴别诊断意义。方法选择130例急性呼吸困难患者,根据临床资料及左室射血分数分为充血性心力衰竭组78例、非充血性心力衰竭组52例。采用干式快速免疫荧光定量分析法检测血浆中的B型钠尿肽浓度。结果充血性心力衰竭组血浆B型钠尿肽浓度为(732±53)ng/L,高于非充血性心力衰竭组的(71±34)ng/L(P<0.01);以B型钠尿肽100ng/L作为阈值区分呼吸困难是否为充血性心力衰竭所致,其敏感性、特异性和准确性分别为92.30%、94.23%和93.07%;在充血性心力衰竭组,B型钠尿肽浓度在心功能不同级别(美国纽约心脏病学会心功能分级Ⅱ、Ⅲ和Ⅳ级)之间差异有统计学意义(P<0.01)。血浆B型钠尿肽>500ng/L常预示猝死发生。结论血浆B型钠尿肽水平对于充血性心力衰竭的诊断具有较高的敏感性、特异性和准确性,对于鉴别呼吸困难是否为心源性具有重要参考意义。

Objective To determine the si gnificance of plasma level of B-type natriuretic peptide (BNP) in patients with congestive heart failure (CHF) for differential diagnosis of their acute dyspne aMethods Totally, 130 patients with acute dyspnea were selected, including 78 patients diagnosed as CHF with left ventricular ejection fraction less than 040 and 52 patients without CHF Plasma level of BNP was m easured by a rapid, point-of-care quantitative immunofluorescent assay Results Plasma level of BNP was(732±53)ng/L in patients wit h CHF, much higher than that in those without CHF(71±34)ng/L(P<001) Sensitivity, specificity and accuracy of plasma BNP measurement with a cut-off value of 100 ng/L in patients with CHF in differential diagnosis for acute dyspn ea were 9230%, 9423% and 9307%, respectively There was significant diffe rence in plasma level of BNP among patients of CHF with varied classes of cardia c function (Ⅱ, Ⅲ and Ⅳ of NYHA classification) (P<001) Plasma level of BNP greater than 500 ng/L usually predicts occurrence of sudden death Conclusions Plasma level of BNP by a point-of-care rapid mea surement is sensitive, specific and accurate in diagnosis for CHF and can be use d in differential diagnosis for cardiac dyspnea