N-末端脑钠肽在心源性与气道炎性疾病致呼吸困难鉴别诊断中的价值

clinical significance of differential diagnosis of plasma Nt-proBNP concentration change between patients with cardiac dyspea and airway inflammatory disease

目的探讨脑利钠肽N端前体肽(Nt-proBNP)在呼吸困难患者中的水平变化及其临床意义。方法用放射免疫法(RIA)分别测定健康人18名及46例呼吸困难患者的血浆Nt-proBNP水平,其中心源性呼吸困难组(CDG)25名和气道炎性疾病组(AIDG)21名,并检测心脏超声、血气分析等指标,然后分别检测其与Nt-proBNP相关性。结果CDG组和AIDG组血浆Nt-proBNP显著高于正常对照组P<0.01;CDG组血浆Nt-proBNP显著高于AIDG组,P<0.01;左室射血分数与Nt-BNP呈负相关(r=-0.662,P=0.000);左室舒张末内径与Nt-BNP呈正相关(r=0.633,P=0.000);左房前后径与Nt-BNP呈正相关(r=0.491,P=0.000)。在AIDG患者中Nt-proBNP水平在氧分压正常组、轻度低氧血症组、中度低氧血症组、重度低氧血症组为逐渐升高,组间比较无统计学差异。结论血浆Nt-proBNP对心源性与气道炎性疾病致呼吸困难有鉴别诊断价值。由于这种标志物在急性不稳定心衰病人明显增高,有希望成为评价心功能的重要补充指标,成为一项常规检查。

Objective To explore chinical significance of differential diagnosis of plasma Nt-proBNP concentration change between patients with cardiac dyspea and airway inflammatory disease. Methods Plasma Nt-proBNP levels were compared among CDG, AIDG,NC by radioimmunoassay, of the total, 18 healthy persons in NC,25 subjects in CDG,21 subjects in AIDG. Further correlation tests of plasma Nt-proBNP levels with left ventricle ejection fraction, heart structure index of Ultrasonography of heart were done. Plasma Nt-proBNP levels trader different oxygen partial pressure were analyzed in AIDG. Results Plasma Nt-proBNP concentrations increased significandy in patients with CDG or AIDG compared with those of normal control, moreover, plasma Nt-proBNP concentrations increased more obviously in CDG than in AIDG, there were significant differences between the two groups, P 〈 0.01. there was negative correlation between Nt-proBNP concentrations and left ventficular ejection fraction （LVEF）among subjects with dyspea, end-diastolic left ventricular inner diameter correlated positively with plasma Nt-proBNP concentrations, and left atrial anteropesterior diameter correlated positively with plasma Nt-proBNP concentrations. Plasma Nt - proBNP levels in oxygen partial pressure normal subgroup, mild hypoxemia subgroup,moderate hypoxemia subgroup,severe hypoxemia subgroup gradually rose in AIDG. There was not statistical difference in group eomparison. Conclusion It suggested plasma Nt-proBNP concentrations had value of differential diagnosis between cardiac dyspnea and airway inflammatory disease dyspea. Because this marker is considerably higher in patients with cardiac dyspnea. As such, Nt-proBNP to become an important routine examination is hopeful for guidelines for the diagnosis of heart failure and evaluation cardiac function.