N端心房利钠肽和N端B型利钠肽原对无症状左心室收缩功能障碍的早期预测价值

The Predicting Value of Plasma Natriretic Peptides for Screening Asymptomatic Left Ventricular Systolic Dysfunction in Patients With High Risk of Heart Failure

目的:比较N端心房利钠肽(NT-proANP)和N端B型利钠肽原(NT-proBNP)对心力衰竭高危人群无症状左心室收缩功能障碍(LVSD)的早期预测价值。方法:根据美国心脏病学会/心脏病协会心功能分期选取A期和B期心血管病患者300例为病例组。另选取136例健康体检者为对照组。记录一般临床情况,采用超声心动图测定左心室射血分数;酶联免疫吸附(ELISA)法测定血浆NT-proANP和NT-proBNP浓度。依据左心室射血分数(以≤0.40为界),将病例组分为无症状LVSD者及有症状LVSD者,比较两者间NT-proANP和NT-proBNP浓度差异,描记NT-proANP和NT-proBNP诊断无症状左心室收缩功能障碍受试者工作特征(ROC)曲线;依据ROC曲线界定最佳分界(cut-off)值。结果:超声心动图检查发现58例无症状LVSD患者。病例组血浆NT-proANP和NT-proBNP浓度显著高于对照组(P<0.01)。无症状LVSD者血浆NT-proANP和NT-proBNP浓度显著高于有症状LVSD者(P<0.05)。受试者工作特征曲线分析结果提示诊断无症状LVSD曲线下面积NT-proANP明显大于NT-proBNP(0.806,P<0.001对0.723,P<0.05)。无症状LVSD预测最佳分界值分别为NT-proANP(1701.77)fmol/ml;NT-proBNP(345.28)fmol/ml,敏感性两者均为88.9%,阴性预测值均>98.5%。结论:血浆NT-proBNP与NT-proANP浓度均能够反映心力衰竭高危人群心脏功能状态,可作为无症状LVSD的筛查指标,早期无症状LVSD筛查NT-proANP效果优于NT-proBNP。

Objective：To assess the predicting value of plasma N-terminal proatrial natriuretic peptide （NT-proANP） and N-terminal pro-brain natriuretic peptide （NT-proBNP） for screening asymptomatic left ventricular systolic dysfunction （ALVSD） in patients with the high risk of heart failure. Methods ： Our research included two groups, Patient group,300 consecutive patients with cardiovascular disease, their cardiac function were at AHA Class A and Class B, the patients were further divided into ALVSD sub-group and non-ALVSD sub-group by left ventricular ejection fraction （LVEF） at the cut-off value of 0. 40. Control group ,there were 136 healthy individuals from re- gnlar physical check-up. The plasma concentrations of NT-proANP and NT-proBNP were measured by enzyme-linked immunosor- bent assay,LVEF was examined by echocardiography. Statistical comparison was performed in both groups. Diagnostic accuracy was evaluated by receiver operating characteristic （ROC） analysis. Results：Plasma levels of NT-proANP and NT-proBNP were significantly higher in Patient group than that in Control group （ P 〈 0.01 ）. Echocardiography found 58 patients with ALVSD, and the NT-proANP and NT-proBNP were much higher in ALVSD sub-group than that in Non-ALVSD sub-group （P 〈 0. 05 ）. ROC analysis indicated the area under the ALVSD curve, NT-proANP was obviously higher than NT-proBNP（0. 806,P 〈0. 001 vs. 0. 732,P 〈0. 05）. The best ALVSD cut-off value for NT-proANP was 1701.77 fmol/ml ,for NT-proBNP was 345.28 fmol/ml respectively,the detective sensitivity was 88. 9% and the negtive pro- deetion value was 〉98. 5% in both NT-proANP and NT-proBNP. Conclusion： Plasma NT-proANP and NT-proBNP level presented the predicting value for screening ALVSD patients with the high risk of heart failure. NT-proANP was better than NT-proBNP for early screening of ALVSD.