血浆心脏标志物对急性呼吸困难的鉴别诊断价值研究

Differentiate diagnostic value of cardiac serum biochemical markers in patients with acute respiratory distress

目的:探讨血浆心脏标志物对急性呼吸困难的鉴别诊断价值。方法:对入选的152例急性呼吸困难患者(病例组)和106例健康者(对照组)行血浆肌钙蛋白I(cTnI)、N端脑钠肽前体(NT-proBNP)检测,并行心脏彩色超声心动图检查确定左室射血分数(LVEF)。以心脏超声心动图结果将病例组进一步分为急性心力衰竭(心衰)组和非心衰组,比较各组间血浆cTnI、NT-proBNP水平;分析病例组中cTnI、NT-proBNP浓度与LVEF值的直线相关关系;计算不同NT-proBNP截点值下对急性心衰的诊断价值。结果:病例组血浆NT-proBNP浓度较对照组增高(P<0.05),尤其是在急性心衰组中(P<0.01);急性心衰组血浆cTnI浓度与非心衰组和对照组比较差异无统计学意义;NT-proBNP浓度与LVEF值呈负相关(P<0.01);cTnI浓度与LVEF值无相关性;NT-proBNP浓度在300ng/L以上的病例急性心衰发生率较低浓度者显著增高;截点值在250ng/L时诊断灵敏度(98.51%)和阴性预测水平(98.04%)最高,随着截点值的提高,特异度和阳性预测率提高明显,截点值为400ng/L时诊断符合度最好(总符合度86.84%,Kappa值0.736)。结论:血浆NT-proBNP浓度对急性呼吸困难患者是否存在急性心衰,显示出良好的预测效力,与左室功能相关性强,对该类患者急性心衰的筛查和心功能评价具有相当价值。

Objective：To investigate the diagnosis value of plasma cardiac biochemical markers in patients with acute respiratory distress. Method：We selected 152 patients suffered from acute respiratory distress in our department, and 106 healthy people, who came for body-check, as control. All the people received blood test for cTnI, NT-proBNP, and echocardiogram examination for left ventricular ejection fraction （LVEF）. According to the echocardiogram results, the patients were divided into two sub groups： the heart failure subgroup and the non-heart failure subgroup. We compared the cTnI and NT-proBNP concentration of the three groups; analyzed the linear correlation relationship between the concentration of cTnI.NT-proBNP and LVEF in patients; evaluated the values of NT-proBNP for the diagnosis of acute heart failure at different cut points. Result： The plasma concentration of NT-proBNP in acute respiratory distress increased significantly （P〈0.05）, especially in acute heart failure group （P〈0.01）. In the three groups, plasma concentration of cTnI was no significant difference in statistics. There was negative linear correlation relationships between the plasma NT-proBNP concentration and LVEF （P〈0.01）, but no linear correlation relationship between plasma concentration of cTnI and LVEF. Morbidity of acute heart failure raised obviously in patients with NT-proBNP concentration over 300 ng/L. Analyzed on different cut point of NT-proBNP concentration, the diagnostic sensitivity and negative predictive value for acute heart failure were the best on 250 pg/ml, the specificity （98. 51% ） and positive predictive value （98.04 % ） increased obviously when cut point raised. And the crude agreement （86.84% ） and kappa value （0. 736） reached the highest level on 400 ng/L. Conclusion：The plasma concentration of NT-proBNP is correlated with left ventricular function, suggesting a good predictive capability of AHF diagnosis and the evaluation of heart function in acute respiratory distress patients.