脑钠肽对高龄呼吸困难患者鉴别诊断作用探讨

B-type natriuretic peptide study in differentiating etiology of dyspnea in the octogenarian

目的评价血浆脑钠肽(BNP)浓度测定在高龄呼吸困难患者中鉴别诊断的作用价值。方法对64例高龄呼吸困难患者根据病史、体征、相关检查确定高龄呼吸困难的主要原因。分为高龄心衰组(33例)和高龄非心源性呼吸困难组(31例),相应设60-79老年(一般老年)对照组。运用快速荧光免疫法测定各组患者血浆BNP浓度。结果高龄心衰组心脏扩大,房颤或房扑发生率及LVEF、BNP值显著高于高龄非心源性呼吸困难组(P<0.01)。高龄心衰组心脏扩大、房颤、房扑发生率及LVEF、BNP值与一般老年心衰组(32例)比较无显著差异(P>0.05)。而高龄非心源性呼吸困难组BNP值显著高于一般老年非心源性呼吸困难组(32例)(P<0.01)。结论BNP对高龄呼吸困难鉴别诊断与一般老年人同样具有特异的重要作用,但在高龄人群中BNP预测值受到增龄的影响,应在鉴别诊断中引起重视。

Objective To assess B type natrinretic peptide（BNP） levels measurement value in differentiating etiology of dyspnea in the octogenarian. Methods 64 octogenarian patients with dyspnea were diagnosed defin/tely according to case history, physical examination, and labemtory examination. They were divided into octogenarian heart failure group（33 case） and octogenarian non- heart failure group（31 case） ,accordingly with 60 - 79 years gerontism patients （commom gerontism） as control group. BNP level of each group were measured with a rapid fluorescence immunoassay.Results incidence rate of ventricle enlargement, Atrial Fibrillation（AF） or Atrial flutter（M）, and LVEF and BNP level in octogenarian heart failure group was significantly higher than octogenarian non-cardiogernic dyspnea group（ P 〈 0.01）.The incidence rate of heart enlargement, AF, or AF, and LVEF and BNPlevel octogenarian heart failure group is not significantly different compared with common gerontism heart failure group（32 ease） （ P 〉 0.05）. Howerer, BNP level in octogenarian non-cardiogenic dyspnea group was significantly higher than common gerontism group （32 case） （ P 〈 0.01）. Conclusion BNP play a important role in differential diagnosis of dyspnea as in the octogenarian as in the common gerontism, but BNP prognostic value in the octogenarian was influenced by aging,which must be recognized in differential diagnosis.