N-端脑钠素前体与心钠素对冠心病慢性心力衰竭诊断及预后判断价值的比较研究

Comparison study on diagnostic and prognostic value of Nterminal probrain natriuretic peptide and atrium natriuretic peptide in chronic congestive heart failure

目的比较N-端脑钠素前体(NT-proBNP)和心钠素(ANP)对冠心病慢性心力衰竭(心衰)的诊断及预后判定价值。方法入选118例冠心病患者,其中伴心衰78例,无心衰40例。用电化学发光法测定血浆NT-proBNP,用放射免疫法测定血浆ANP,并与40例正常人进行比较。定期随访、记录冠心病患者心脏事件的发生情况。结果心衰患者血浆NT-proBNP和ANP浓度均显著高于无心衰患者及正常人组(P均<0.05)。心功能IV级者NT-proBNP浓度显著高于心功能Ⅱ、Ⅲ级者,血浆ANP浓度显著高于心功能Ⅲ级者,但与Ⅱ级者比较差异无显著性。血浆NT-proBNP和ANP对于冠心病心衰诊断的敏感性分别为91.25%和73.46%;特异性分别为90.25%和80.33%。心衰组中死亡者与存活者血浆NT-proBNP和ANP水平差异无显著性。结论NT-proBNP对冠心病心衰的诊断价值高于ANP,二者均与冠心病心衰患者短期心源性死亡无关。

Objective To investigate the diagnostic and prognostic value of nterminal-probrain natriuretic peptide（NT-proBNP） and atrium natriuretic peptide （ANP）in chronic congestive heart failure. Methods One hundred and eighteen coronary heart disease patients were enrolled in the study. Among them 78 patients were accompanied by heart failure and 40 with no heart failure. Plasma NT-proBNP was determined with Elecsys Chemiluminescence Immunoassay method, and plasma ANP was determined with radioimmunoassay method.The results were compared with those of 40 healthy in dividuals. All patients were followed up accordingly. Results Compared with patients with no heart failure and healthy individuals, the patients with heart failure had a higher plasma NT-proBNP and ANP contents （P〈0.05）. Cardiac function grade IV patients had a significantly higher plasma NT-proBNP than cardiac function grade Ⅱ and Ⅲ patients,and their plasma ANP level was significanthy higher than that of cardiac function grade Ⅲ patients,but there was no significantly difference in ANP content between cardiac function grade Ⅳ and Ⅱ.The diagnostic sensitivity of NT-proBNP and ANP was 91.25% and 73.46%, respectively. The diagnostic specificity of NT-proBNP and ANP was 90.25%, 80.33%, respectively. In the heart failure group, it was found that there was no significant difference in the plasma NT-proBNP and ANP between the deaths and surviving patients. Conclusion The diagnostic value of NT-proBNP in chronic heart failure is higher than that of ANP.According to our followup result,the plasma NT-proBNP and ANP can not be relied up on to predict short -term cardiogenic death in heart failure.