B型尿钠肽对心源性胸腔积液的诊断价值

Diagnostic Value of B-type Natriuretic Peptide for Cardiac Origin Pleural Effusions

目的探讨测定浆膜腔积液中B型尿钠钛(BNP)对心源性积液的诊断价值。方法检测274例有胸腔积液的患者(其中87例为心衰患者)胸腔积液中的BNP。结果87例心力衰竭患者胸腔积液BNP的中位数水平为1 785 pg/ml(785～1 998 pg/ml),明显高于肝硬化354 pg/m(l254～542 pg/ml)、恶性积液521 pg/m(l257～625 pg/ml)、结核323 pg/ml(205～520 pg/ml)、肺炎252pg/m(l180～353 pg/ml)、肾功衰竭303 pg/m(l128～539 pg/ml)和肺栓塞410 pg/m(l313～786pg/ml)。恶性积液、肺栓塞组高于除心力衰竭组以外的其他各组,但差异无显著性(P>0.05)。取BNP水平≥658 pg/ml为截断值时,该实验的敏感性为84%,特异性为88%,BNP在ROC曲线下的面积92%。结论胸腔积液中BNP的检测对源于心衰的积液有诊断意义。

Objective To investigate diagnostic value of B-type natriuretie peptide （BNP） in pleural fluid for determining cardiac origin pleural effusion. Methods BNP levels in Pleural fluid in 274 patients（87 of them had heart failure） were measured. Results The median pleural fluid BNP levels in patients with heart failure were significantly higher （1 785 pg/ml;785-2 587 pg/ml）than in patients with hepatocirrhosis （ 354 pg/ml ; 254-542 pg/ml ）, malignant pleural effusion （ 521 pg/ml ; 257-625 pg/ml ）, tuberculosis （ 323 pg/ml ; 205-520 pg/ ml ）, pneumonia （ 252 pg/ml ; 180-353 pg/ml ）, renal failure （ 303 pg/ml ; 128-539 pg/ml ）and pulmonary embolism （ 410 pg/ml ; 313-786 pg/ ml ） （ P 〈 0.01 ）. The median BNP levels in pleural fluid in patients with malignant pleural effusion group and pulmonary enbolism group were higher than other groups except heart failure group while there was no significant difference between these two groups （P 〉 0.05 ）.At a cut-off point of 658 pg/mL,the sensitivity of this test is 84% and the specificity is 88 % for diagnosis of heart failure.The area under the curve of BNP was 0.92 on a receiver-operating eharaeteristie eurve. Conclusion BNP measurement in pleural fluid may be useful in the diagnosis of pleural effusion resulting from heart failure.