血浆氨基末端脑利钠前体水平对急性心源性呼吸困难的诊断价值

Diagnostic value of N-termina pro-brain natriuretic peptide in patients with acute cardiac dyspnoea

目的探讨血浆氨基末端脑利钠前体(NT-proBNP)水平对急性心源性呼吸困难的诊断价值。方法选择由我院急诊室转入心内科的98例急性呼吸困难患者,采用双抗体夹心免疫荧光法(ELMA)检测血浆NT-proBNP水平,并进行包括心脏超声在内的心肺功能相关检查,由2名心内科专家做出急性心衰的最终临床诊断。结果①急性心衰组的62例患者的血浆NT-proBNP水平中位数显著高于无急性心衰组的36例患者:3411pg/mLvs106pg/mL,P<0.001。②二项logistic回归分析显示:血浆NT-proBNP水平的增加是急性心衰诊断的最强因子(OR=8.424,95%可信区间为1.003～1.014,P=0.004)。③NT-proBNP水平对急性左心衰判定的ROC曲线下面积为0.978,95%可信区间0.954～1.001,P<0.001,对急性左心衰的阳性预测价值为97.8%,阴性预测价值为2.2%;入选急性心衰诊断的NT-proBNP最佳截止点为483pg/ml(敏感性93.5%,特异性91.7%)。结论血浆NT-proBNP水平是区分呼吸困难患者是否患有急性心衰的有价值检查手段。

Objective The purpose of this study was to evaluate the value of NT-proBNP on discriminating between cardiac and non cardiac dyspnoea. Methods 98 consecutive patients with dyspnoea referred from emergency department were included in this study. After enrollment, all plasma samples were collected for NT-proBNP measurement using a sandwich im- munoassay （ELMA）with two antibodies. Provided with all hospital records including echocardiography, 2 study cardiologists determined the diagnosis for each patient. Results （1）Among patients who had acute CHF, the median NT-proBNP level was 3411pg/mL （interquartile range 1432 to 7175）, which was significantly higher compared with 106pg/mL（interquartile range 60 to 286） among patients who did not have acute CHF （P〈0.001）. （2）By binary logistic regression analysis, the strongest predictor of acute CHF was an increased NT-proBNP level （OR 8.424,95% CI 1.003-1.014, P=-0.004 ）. （3）Receiver-operating-characteristic （ROC） demonstrated NT-proBNP was highly sensitive and specific for the diagnosis of acute CHF （area under the curve was 0.978, 95% CI 0.954-1.001, P〈0.001; positive predictive value 97.8%, negative predictive value 2.2%）.The optimal outpoint was 483 pg/mL, which was 93.5% sensitive and 91.7% specific for ruling in the diagnosis of acute CHF. Conclusion Plasma level of NT-proBNP is an effective method on discriminating between cardiac and non cardiac dyspnoea.