N末端B型利钠肽原对单纯主动脉瓣关闭不全心力衰竭患者的诊断价值

The Diagnostic Value of N-Terminal Pro-B Type Natriuretic Peptide in Aortic Regurgitation Patients With Heart Failure

目的:评价N末端B型利钠肽原(NT-proBNP)对单纯主动脉瓣关闭不全(AR)心力衰竭患者的诊断价值。方法:使用酶联免疫的方法对27例单纯AR心力衰竭患者(单纯AR心力衰竭组)和76例正常对照者(正常对照组)行NT-proBNP测定,评价其对单纯AR心力衰竭的诊断价值。结果:与正常对照组相比,单纯AR心力衰竭组的NT-proBNP水平显著升高(P<0.05),差异有统计学意义;纽约心功能分级(NYHA)Ⅰ、Ⅱ级者差异无统计学意义;NYHAⅢ级者显著升高5.2倍,也显著高于NYHAⅠ、Ⅱ级者,差异均有统计学意义。在左心室舒张期末内径(LVEDD)>60 mm者显著高于LVEDD≤60 mm者(P<0.05),在合并心房颤动者也显著高于窦性心律者(P<0.01),差异均有统计学意义。当NT-proBNP阈值在1 340 pg/ml时,是诊断单纯AR心力衰竭(受试者工作特性曲线下面积=0.699,P<0.01)的最佳阈值;诊断的敏感性、特异性和准确性分别为59.26%、96.05%和86.41%。单因素分析,Log(NT-proBNP)仅与心功能(P=0.002)和LVEDD(P=0.033)呈显著正相关;多元逐步回归分析只有心功能与NT-proBNP呈独立相关。结论:NT-proBNP对单纯AR心力衰竭患者有重要诊断价值。诊断单纯AR心力衰竭的最佳阈值为1 340 pg/ml,准确性高达86.41%。

Objective：To evaluate the diagnostic value of N-terminal pro-B type natriuretic peptide （NT-proBNP） in aortic regurgitation （AR） patients with heart failure. Methods：We summarized 27 AR patients with heart failure （Patient group） for blood level of NT-proBNP by ELISA, the pa- tients were treated in our hospital from 2005 to 2006, and meanwhile, took 76 normal subjects as Control group. The diagnostic value of NT-proBNP for heart failure was assessed and compared in both groups. Results ： Blood level of NT-proBNP was significantly higher in Patient group than that in Control group, P 〈 0. 05, it was 5.2 times higher in patients with NYHA class m than those in Control group P 〈0. 01 and those in NYHA class I , II ,respectively. NT-proBNP was higher in patients with left ventricular end-diastolic diameter （LVEDD） 〉 60 mm than those with LVEDD ≤ 60 mm, P 〈 O. 05. It was higher in patients with atrial fibrillation than those with sinus rhythm,P 〈 0.01. The best cutoff value of NT-proBNP was 1 340 pg/ml for heart failure diagnosis （ROC =0. 699 ,P 〈0. 01 ） ,the sensitivity ,specificity and accuracy were59. 26% ,96. 05% and 86. 41% respectively. Univariate analysis indicated that Log（NT-proBNP） was positively related to cardiac function and LVEDD,P = 0. 002,P = 0. 033 respectively. Multiple regression analysis presented that NT-proBNP was positively related to cardiac function. Conclusion ： NT-proBNP was important for diagnosing heart failure in AR patients, the best cutoff value was 1 340 pg/ml with the diagnostic accuracy of 86.41%.