血管外肺水联合血清N末端B型钠尿肽原检测在急性呼吸困难鉴别诊断中的应用

Application of Extravascular Lung Water and Serun N-terminal Probrain Natrinretic Peptide in Differentiation of Acute Dyspnea

目的探讨血管外肺水(EVLW)及血清N末端B型钠尿肽原(NT-proBNP)变化在急性心源性与非心源性呼吸困难患者中诊断和鉴别诊断的临床意义。方法选择我院2006年10月—2008年11月以呼吸困难为主诉就诊的患者130例,分为心源性呼吸困难组70例,非心源性呼吸困难组60例,同时按照纽约心功能分级标准(NY-HA)对心力衰竭患者进行分级。采用PiCCO监测EVLW及中心静脉压(CVP),电化学发光法测定患者血清NT-proBNP水平,比较两组EVLW及NT-proBNP的差异。结果心源性与非心源性呼吸困难组患者的EVLW水平分别为(715±53)ml和(527±95)ml,差异有统计学意义(P<0.01);心源性呼吸困难组EVLW与CVP水平呈正相关(r=0.750,P<0.01)。心源性与非心源性呼吸困难组血清NT-proBNP水平分别为(1215±386)ng/L和(196±40)ng/L,差异有统计学意义(P<0.01);不同NYHA心功能亚组间血清NT-proBNP水平比较差异有统计学意义(P<0.05);心源性呼吸困难组血清NT-proBNP水平与左室射血分数之间呈负相关(r=-0.601,P<0.01)。结论EV-LW及NT-proBNP对心源性呼吸困难和非心源性呼吸困难的诊断和鉴别诊断有实际意义。

Objective To investigate the clinical value of changes of extravascular lung water （EVLW） and serum N -terminal pro -brain natriuretic peptide （NT -proBNP） in diagnosis and differentiating diagnosis of acute cardiac dyspnea or noncardiac dyspnea. Methods Totally 130 patients with acute dyspnea, in our hospital from October 2006 to November 2008, were divided into two groups ： cardiac dyspnea group （ n = 70） and noncardiac dyspnea group （ n = 60）. At the same time, the heart function was classified according to NYHA. The extravascular lung water and central vein pressure （CVP） were measured by PiCCO. The serum NT - proBNP level was measured by an automated electrochemiluminescence immunoassayan Roche Elecsys 2010. The results of EVLW and NT - proBNP were compared. Results The EVLW levels of the cardiac dyspnea and non- cardiac dyspnea groups were （715 ± 53 ） ml and （527 ± 95 ） ml respectively, with a significant difference （P 〈 0.01 ）. A positive correlation was found between plasma EVLW and CVP in cardiac dyspnea group （r =0. 750, P 〈0. 01 ）. The serum NT - proBNP levels of cardiac dyspnea and noncardiac dyspnea groups were （ 1 215 ±386） ng/L and （ 196 ±40） ng/L respectively （ P 〈 0. 01 ）. The significant difference was also found among the subgroups with different NYHA grades （ P 〈 0. 05 ）. A negative correlation was found between plasma NT - proBNP and left ventricle ejection fraction （LVEF） in the cardiac dyspnea group （ r = -0. 601, P 〈 0. 01 ）. Conclusion The levels of EVLW and NT - proBNP are of clinical value to diagnosis and differentiating diagnosis of acute cardiac and acute non - cardiac dyspnea.