脑钠素对心源性呼吸困难的诊断价值

Diagnostic significance of brain natriuretic peptide in cardiac dyspnea

目的 探讨血浆脑钠素（BNP）水平对心源性呼吸困难的诊断价值。方法 采用特异性放射免疫法测定慢性心力衰竭（CHF）引起的呼吸困难患者（n=52）和非CHF引起呼吸困难患者（n=30），以及健康志愿者（正常对照组，n=28）血浆BNP浓度，并进行组间比较。结果 CHF组BNP浓度均显著高于非CHF组及正常对照组[（649．80±141．72）pg／mL比（59．08±18．60）pg／mL和（65．20±16．32）pg／mL，P〈0．05]，而非CHF组与正常对照组BNP浓度无显著差异，不同NYHA心功能分级患者的血浆BNP浓度随心功能级别增加而显著增高，CHF患者血浆BNP浓度与左室射血分数（LEVF）水平呈显著负相关（r=-0．673，P〈0．001）。受试者工作特征曲线（ROC曲线）下面积为0．91（0．88～0．98，P〈0．001），最佳界值（206pg／mL）时的敏感性、特异性、阳性预测值和阴性预测值分别为87．2％，86．8％，84．2％和91．8％。结论 血浆BNP是诊断心源性呼吸困难的一项很有价值的指标。

Objective To evaluate the diagnostic value of brain uatriuretie pepfide （BNP） for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure（CHF）（n=52）or without CHF（n=30）and normal control group（n=28）.Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [（649.80 ± 141.72） pg/mL vs （59.08 ± 18.60） pg/mL and （65.20 ± 16.32） pg/mL, respectively, P 〈 0.05]. There was no significant difference of BNP level between dyspnea patients without CHF and normal group （ P 〉 0.05）. The plasma BNP level elevated with the worsening of heart failure （ NYHA Classiffication）. The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction （r = -0.673, P 〈 0.001 ）. The receiver operating characteristic （ROC） curve analysis showed that the area under the ROC curve （AUC） is 0.91（0.88-0.98, P 〈 0.001 ） with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL. Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.