氨基端前脑钠肽和老年人左心室功能不全

Serum N-terminal pro-brain natriuretic peptide and elderly patients with left ventricular dysfunction

目的评价氨基端前脑钠肽(NT-proBNP)在诊断老年人左心室功能不全(LVD)的价值。方法用电化学发光免疫学方法(Elecsys,罗氏诊断)检测102例LVD老人和98名健康老人(对照组)血NT-proBNP,分析各种临床因素与NT-proBNP之间的关系。结果正常对照组NT-proBNP(中位数)为53.25pg/mL,与左心室射血分数(LVEF)、血肌酐的关系密切,和年龄、性别无关。LVD老人NT-proBNP随着心功能分级(纽约心脏学会NYHA)的增加而升高。NT-proBNP还同LVEF呈良好的负相关(r=-0.735,P<0.001),不同LVEF的各组LVD患者间NT-proBNP水平有显著差异(P<0.001)。多因素线性回归分析发现,NYHA心功能分级和LVEF的存在对NT-proBNP有影响。NT-proBNP探测老年人LVD的受试者工作特性曲线下面积(AUC)为0.97,界值117.6pg/mL的灵敏度91.1%,特异度95.9%。结论NT-proBNP水平是确定老年人LVD的良好指标,与心力衰竭的严重程度以及左心室功能密切相关。

Purpose Aminoterminal portion of pro-brain natriuretic peptide （NT-proBNP） appears to be useful in the screening, diagnosis and prognosis of left ventricular dysfunction （LVD） and congestive heart failure. The purpose of this study was to determine the values of serum NT-proBNP in Shanghai elderly patients with LVD. Methods We measured serum NT-proBNP in 102 elderly patients with LVD （87 males） and 98 healthy elderly （71 males） as the control. The NT-proBNP was measured by using Elecsys 2010 （Roche Diagnostics, Switzerland）. Results The concentrations of NT-proBNP （median） in control subjects were 53.25 pg/mL and multi-factors linear regression analysis showed that left ventrieular ejection fraction （LVEF） and ereatinine might correlate to NT-proBNP excluding other factors. There were no difference of age and sex. In 102 elderly patients with LVD, NT-proBNP level elevated with New York Heart Association （NYHA） classification increased. The difference was significant （P〈0. 001）. NT-proBNP level showed a negative correlation with LVEF （r = -0. 735, P〈 0. 001 ）. Multi-factors linear regression analysis showed that NYHA classification and LVEF might correlate to NT-proBNP excluding sex, age and clinic history. The area under the receiver operator characteristic curve （AUC） were 0.97 and the cut-off level was determined as 117.6 pg/mL for NT-proBNP giving a sensitivity of 91. 1 % and specificity of 95.9%. Conclusions The NT-proBNP level is a sensitive indicator of LVD also in elderly patients and may trigger further cardiac investigation.