血浆B型利钠肽浓度对心力衰竭诊断及预后判断的作用

Role of plasma B type natriuretic peptide concentration in the diagnosis and predicting prognosis of patients with heart failure

目的探讨血浆B型利钠肽(B type natriuretic peptide,BNP)浓度对心力衰竭(heart failure,HF)诊断及预后判断的作用。方法荧光免疫法测定90例呼吸困难患者血浆BNP浓度,心脏超声测定心脏左室射血分数(LVEF),漂浮导管法测定肺毛细血管楔压(PCWP)。按美国心功能分级标准进行心功能分级。HF患者根据出院时血浆BNP浓度分为BNP＜400 ng/L组和BNP≥400 ng/L两组,对两组患者因HF 30 d内再次住院率进行对比。结果HF组患者血浆BNP浓度(569±222)ng/L明显高于非HF组患者(52±10)ng/L(P＜0．01),随着HF的加重,血浆BNP浓度逐渐升高。HF患者BNP浓度与PCWP呈正相关(r= 0．55,P＜0．01),与LVEF呈负相关(r=-0．62,P＜0．01)。如以100 ng/L为正常参考值,BNP诊断HF的敏感性为94．7%,特异性为91．7%,排除HF的阴性预测价值为96．7%。不同原发病患者血浆浓度的差异无显著性(P＞0．05)。出院时血浆BNP浓度≥400 ng/L组30 d内因HF再次住院率升高(P＜0．05)。结论血浆BNP浓度可作为HF诊断和预后判断的指标。

Objective To study the role of plasma B type natriuretic peptide （ BNP ） concentration in the diagnosis and predicting prognosis of patients with heart failure （HF）, Methods Plasma BNP concentration was measured with immunofluorescence assay in 90 patients with dyspnea. Left ventricular ejection fraction （LYEF） and pulmonary capillary wedge pressure （PCWP） were determined by echocardiography and Swan - Ganz catheter respectively in these patients at the same time, The gradation of HF was based on the criteria of cardiac function classification setted by New York Heart Association （NYHA） , The HF patients were classified into 2 groups according to BNP concentration measured just before the discharge： patients with BNP 〈 400 ng/L and BNP≥ 400 ng/L. The re-admission rate within 30 days because of the HF between the two groups was compared, Results Plasma BNP levels were higher in the patients with left heart failure than those in the non - heart failure patients [ （569 ± 222） ng/L vs. （52 ± 10） ng/L, P 〈 0.01], and BNP levels were increased in accordance with the severity of HF. The sensitivity, specificity, and negative predictive values of plasma BNP levels ≥ 100 ng/L for predicting HF were 94.7%, 91.7% and 96.7%, respectively. Plasma BNP levels were positively related to PCWP （r = 0.55, P 〈 0.01）, and negatively related to LVEF （r = - 0.62, P 〈 0.01） . There was no significant difference of plasma BNP levels between patients with different causes of HF. The re-admission rate within 30 days after discharge was notably high if the plasma BNP concentrations were over 400 ng/L. Conclusion Plasma BNP concentration can be regarded as a valuable marker for diagnosis and predicting prognosis of patients with HF.