氨基端前脑钠肽在老年气急患者中的诊断价值

Utility of Aminoterminal portion of pro-brain natriuretic peptide in differentiating heart failure in elderly patients with dyspnoea

目的探讨氨基端前脑钠肽(NT-proBNP)水平能否鉴别老年人心源性气急以及在老年气急患者中诊断心力衰竭(HF)的价值。方法用电化学发光免疫学方法(Elecsys罗氏诊断)检测84例以气急为主诉的老年患者血NT-proBNP。两名心内科医生根据全部资料(除外NT-proBNP)对每一位患者气急的病因作出三类诊断:HF所致、有左心室功能不全史非心源性和左心室功能基本正常。比较三组患者血NT-proBNP水平。结果三组患者血NT-proBNP(中位值)分别为1807.0、402.7、138.6 pg/mL,各组间差异有显著统计学意义(P<0.001)。界值862.8 pg/mL探测老年人HF气急的受试者工作特性曲线下面积(AUC)为0.967,灵敏度87.0%,特异度94.7%。结论NT-proBNP在老年气急患者中能成为诊断和排除HF的有用标记,但它不是一个独立的检查,医生仍需参考病史、体征及其他辅助检查来综合判断。

Objective Aminoterminal portion of pm- brain natriuretic peptide （NT- proBNP） appears to be higher in the patients with heart failure（HF） than in patients with dyspnoea from other causes. The purpose of this study is to evaluate the utility of NT- proBNP in the elderly patients with acute dyspnoea. Methyls The NT - proBNP was measured by using Elecsys 2010 （Roche Diagnostics, Switzerland）. HF diagnosis was adjudicated by two cardiologists using all the information except NT - proBNP concentration. Results HF patients had significantly higher NT- proBNP values than patients with non - cardiac dyspnoea （ 1807.0 vs. 402.7 and 138.6; P 〈 0.001 ）. The area under the receiver operator characteristic curve （AUC） for prediction of HF were 0.967 and the cut- off level was determined as 862.8 pg/mL for NT - proBNP giving a sensitivity of 87.0% and specificity of 94.7%. Conclusion An abnormal NT - proBNP concentratina is an accurate diagnostic test both for detection and exclusion of HF in the elderly patients with acute dyspnoca. The elevated NT -proBNP merely indicates the presence of ‘cardio- renal distress＇ and we should refer to disease history, symptom and other assistant examination for diagnosis.