血浆N-末端B型利钠肽原检测对呼吸困难鉴别诊断的价值

Differential diagnosis value of N-terminal pro-B-type natriuretic peptide in patients with dyspnea

目的探讨血浆N-末端B型利钠肽原(NT-proBNP)水平的检测对呼吸困难的鉴别诊断价值。方法对92例因呼吸困难入院的患者和20例健康成年人(对照组)行血浆NT-proBNP检测,并作超声心动图检查确定左室射血分数(LVEF)。92例患者中有呼吸困难无充血性心力衰竭(CHF)为肺源性呼吸困难组(Ⅰ组),20例;呼吸困难由慢性阻塞性肺部疾病与肺心病心力衰竭共同引起者为心肺源性呼吸困难组(Ⅱ组),21例;诊断为CHF引起的呼吸困难为心源性呼吸困难组(Ⅲ组),51例。结果心源性呼吸困难患者的NT-proBNP明显高于心肺源性呼吸困难、肺源性呼吸困难及对照组,而LVEF值低于后3组,差异有统计学意义(P均<0.01);NT-proBNP浓度与LVEF值呈负相关(r=-0.71,P<0.05)。结论检测呼吸困难患者的NT-proBNP,联合超声心动图检测可鉴别呼吸困难的病因,对于心源性和非心源性呼吸困难的早期诊断和鉴别诊断有重要的意义。

Objective To investigate the differential diagnosis value of serum N-terminal pro-B-type natriuretic peptide （NT-proBNP） levels in patients with dyspnea. Methods A total of 92 patients with dyspnea were enrolled in this study, and 20 healthy subjects served as norreal control （control group）. The levels of serum NT-proBNP and left ventricular ejection fraction （LVEF） by echocardiography were detected in all the people. In 92 patients with dyspnea ,there were 20 patients with pulmonary dyspnea but no heart failure served as group Ⅰ ,21 patients with dyspnea by chronic obstructive pulmonary disease and cor pulmonale served as group Ⅱ, 51 patients with dyspnea by congestive heart failure served as group m. Results The levels of serum NT-proBNP were higher while LVEF were lower in group Ⅱ than those in group Ⅰ, group Ⅱand control group （ all P 〈 0. 01 ）. The concentration of NT-proBNP had a negative correlation with LVEF （ r = - 0. 71 ,P 〈 0. 05 ）. Conclusions Measurement of concentration of NT-proBNP is helpful to diagnose heart failure and differentiate cardiac and non-cardiac dyspnea.