肥胖急性心衰患者BNP切点的临床探讨

Clinical study of incisor point of BNP in obese patients with acute heart failure

目的:探讨肥胖急性心衰患者的血浆脑钠肽(BNP)切点,为更科学地诊断、评估、治疗心衰以及判断预后提供依据。方法:对住院治疗的68例肥胖(体重指数>23kg/m2)急性心衰患者,采用美国Cardio Dynamics公司生产的无创心排量(ICG)模块,利用生物阻抗法进行无创血流动力学监测,计算出心排量和其它血液动力学参数,采用Triage BNP检测仪进行床旁即时BNP检测。急性心衰判断根据临床症状和血流动力学检测结果确定,分析不同BNP切点的敏感性与特异性,建立受检者工作特征曲线(ROC)。结果:肥胖急性心衰患者的BNP切点在80.4pg/ml时,ROC曲线下面积0.922,敏感性94.02%、特异性72.17%、准确性83.11%、阴性预测值88.45%、阳性预测值79.51%,对心衰诊断效率最高。结论:肥胖急性心衰患者血浆BNP的切点取80.4pg/ml时,对心衰诊断效率最高,其切点的建立可提高对心衰诊断的准确率。

Objective： To explore incisor point of plasma brain natriuretic peptide（BNP） in obese patients with acute heart failure and provide evidence for more scientific evaluation,treatment and judgment of prognosis of heart failure.Methods： A total of 68 obese（body mass index,BMI23 kg/m2） inpatients with acute heart failure were enrolled.Module of impedance cardiogram（ICG,Cardio Dynamics Company,U.S.） and bioelectrical impedance method were used to perform non-invasive hemodynamic monitoring,cardiac output and other hemodynamic parameters were calculated then.Triage BNP detection machine was used to perform bedside BNP real-time detection.Judgment of acute heart failure was made according to clinical symptoms and hemodynamic detected results,and sensitivities and specificities of different incisor points of BNP were analyzed and receiver operating characteristic（ROC） curves were established.Results： When incisor point of BNP of obese patients with acute heart failure was 80.4pg/ml,the area under ROC curve was 0.922,sensitivity was 94.02%,specificity was 72.17%,accuracy was 83.11%,negative predictive value was 88.45% and positive predictive value was 79.51%,which possessed the highest diagnostic efficiency for heart failure.Conclusions： When incisor point of BNP in obese patients with acute heart failure is 80.4pg/ml,it possesses the highest diagnostic efficiency for heart failure.