血浆BNP水平对老年人心源性和肺源性呼吸困难鉴别的临床研究

Clinical Study of Plasma BNP Levels in Differentiating Etiology of Dyspnea in the Elderly Patients

目的探讨血浆B型钠尿肽(BNP)水平在老年人心源性和肺源性呼吸困难鉴别诊断中的临床意义。方法回顾分析136例老年呼吸困难患者,入院后2h内采用酶联免疫吸附法检测血浆BNP浓度。将136例患者根据原发病分为3组,A组:单纯CHF组(43例);B组:肺病组(40例);C组:CHF+肺病组(53例)。A、C组中存在CHF者83例,诊断参照Framingham标准。NYHA心功能Ⅱ级28例,Ⅲ级30例,Ⅳ级25例。分别对各组BNP水平并进行统计学分析。结果A组BNP水平为(714±311)ng/L;B组为(68±31)ng/L;C组为(501±312)ng/L。各组间BNP水平比较差异有统计学意义(P<0.01)。83例CHF患者BNP水平分别为NYHA心功能Ⅱ级(374±221)ng/L、Ⅲ级(634±336)ng/L、Ⅳ级(964±321)ng/L,组间差异有显著性(P<0.01)。结论血浆BNP水平测定对老年性心源性和肺源性呼吸困难的快速鉴别诊断具有较重要的意义。BNP测定是反映心功能的一个敏感指标。

Objective To discussed the differential diagnostic value of plasma BNP levels in the elderly patients with dyspnea. Method The final diagnosis was as follows： the dyspnea was caused by CHF, or pulmonary disease （PD）, or both CHF and PD, or other problems except CHF or PD. Enzyme-linked immunosorbent assay method was used to measure the levels of serum BNP in 136 patients with dyspnea. Results It was found that there were 43 patients with dyspnea in CHF group, and 40 patients with dyspnea in PD group among the 136 patients ; while 53 patients＇ symptoms were caused by combination of CHF and PD. Their BNP levels was （714±311 ） ng/L, （68±31 ） mg/L, （63 ±27） mg/L, （501±312） ng/L, respectively. The BNP levels of CHF group were significantly higher than those of other groups （P〈0.01）. Plasma BNP levels increased significantly accordingly to different New York Heart Association（NYHA） functional classes [class Ⅱ ： （374±221） ng/L, class m： （634±336） ng/L, class IV： （964±321） ng/L, P〈 0.01]. Conclusion The rapid assay of plasma BNP concentration is useful in differentiatial diagnosis in elderly patients with dyspnea （ heart failure vs pulmonary disease）, and plasma BNP is a sensitive index in CHF.