心力衰竭患者B型利钠肽的测定与评价

Value of B-type natriuretic peptide in patients with congestive heart failure

目的:研究B型利钠肽(BNP)在心力衰竭诊断中的应用。方法:采用双抗夹心免疫荧光法检测342例患者的BNP浓度。其中充血性心衰(CHF,心源性)组179例,肺源性心衰组27例,无心衰的对照组136例。结果:(1)在无心衰对照组中,年龄小于55岁组的心源性浓度均值为(35.10±31.93)pg/ml,55～64岁组为(42.85±34.55)pg/ml,65～74岁组为(58.23±25.37)pg/ml,≥75岁组为(60.66±48.95)pg/ml,各组间BNP浓度均值虽随年龄呈上升趋势但无显著差异;(2)对照组中男性BNP浓度为(42.83±38.01)pg/ml,女性为(49.47±48.14)pg/ml,两者无显著差异;(3)在342例患者中BNP以100pg/ml为CHF的判断值时,其敏感性达92.8%,特异性达83.2%,阳性预测值达86.2%,阴性预测值达91.2%;(4)CHF(心源性)患者的BNP浓度均值为(1019.13±972.88)pg/ml,肺源性心衰组为(299.88±275.5)pg/ml,对照组为(45.86±42.89)pg/ml,CHF(心源性)组BNP水平显著高于其他两组,肺源性心衰组又显著高于对照组(P均<0.001)。结论:BNP测定不仅可以作为CHF诊断的一个重要指标,还可用于参考性区分心源性心衰和肺源性心衰,为选择治疗方案提供依据。

Objective：To investigate the value of B-type natriuretic peptide （BNP） in the diagnosis of cogestive heart failure（CHF）. Methods： A total of 342 patients were enrolled in this study, including 179 CHF patients of cardiac origin, 27 CHF patients of pulmonary origin and 136 controls without CHF. Plasma BNP level were measured using fluo rescence assay. Results： In the control group,the plasma BNP level increased with ages respectively,they were （35. 10± 31. 93） pg/ml in the ≤55 years group, （42.85±34. 55） pg/ml in the 55-64 years group, （58.23±25. 37） pg/ml in the 65-74 years group and （60. 66 ± 48. 95）pg/ml in the ≥75 years group, but not significantly difference between group to group ; （2） BNP concentrations in the male and female control subjects were respectively （42.83±38. 01）pg/ ml and （49. 47±48.14）pg/ml, and there was no significant difference between them. ;（3） When 100 pg/ml was used as cutoff value to diagnose CHF, the sensitivity,specificity, positive-predictive value （PPV） and negative-predictive value （NPV） were 92. 8%,83.2%, 86.2% and 91.2% respectively; （4） BNP concentration in CHF of cardiac grigin group[（1019. 13±972. 88）pg/ml] was much higher than those in CHF of pulmonary origin group [（299. 88±275. 5） pg/ml],and control group [（45.86±42.89） pg/ml] ,and BNP level of CHF of pulmonary origin group was more than that in control group, P〈0. 001 all. Conclusion：BNP was not only an important biomarker for the diagnosis of CHF, but also can be used to differentiate heart failure of cardiac origin from of pulmonary origin.