脑钠肽水平测定在急诊呼吸困难病因鉴别中的价值

Value of BNP in the Identification of Dyspnea in Emergency

[目的]探讨血浆脑钠肽水平测定在急诊呼吸困难鉴别诊断及病情评估中的价值。【方法】测定138例急诊呼吸困难患者的血浆BNP浓度，其中88例行超声心动图仪检查测定左室射血分数（LVEF）。依据病史和相关检查分为心源性呼吸困难组及非心源性呼吸困难组，比较BNP水平，同时依心脏彩超结果分为EF〉50％、EF30％～50％、EF〈30％三组进行BNP水平比较，对心源性呼吸困难组按NYHA心功能分级及基础病因分组比较BNP水平。【结果】心源性呼吸困难组BNP水平明显高于非心源性呼吸困难组，差异有显著性（P〈0.01）；随射血分数下降，BNP水平也逐渐增高，组间比较差异有显著性（P〈0．01）；心源性呼吸困难患者随NYHA分级增高其BNP水平越高，组间比较差异有显著性（P〈0．01）；按基础病因分类扩心病患者BNP水平明显高于冠心病及高心病患者（P〈0．01）。[结论]BNP水平测定对于急诊呼吸困难的鉴别对患者心功能的评估有重要价值。

[Objective]To explore the value of brain natriuretic peptide（BNP） in the differential diagnosis and condition evaluation of dyspnea in emergency. [Methods]Plasma BNP level of 138 cases of emergency dyspnea patients was measured. Echocardiography was used to detect the left ventricular ejection fraction （LVEF） of 88 cases. According to the history and the related examination, patients were divided into cardiac dyspnea group and non-cardiac dyspnea group, and BNP level was compared between two groups. According to the result of color uhrasonograpy of the heart, the patients were divided into EF〉50% group, EF 30% 50%group and EFG30% group, and BNP level was compared among three groups. For cardiac dyspnea group, BNP level was compared according to NYHA classification and etiology. [Results]The BNP level in cardiac dyspnea group was obviously higher than that in non-cardiac dyspnea group, and there was significant difference（ P〈0.01）. With the decreasing of LVEF, the BNP level gradually increased, and there was signif icant difference among three groups（ P〈0.01）. With the increasing of NYHA classification, the BNP level of patients with cardiac dyspnea elevated, and there was significant difference among three groups（ P〈0.01）. According to the etiological classification, the BNP level of patients with dilated cardiomyopathy was obviously higher than that in patients with coronary heart disease or hypertensive heart disease（ P〈0.01 ）. [Conclusion] BNP can be used for the identification of emergency dyspnea, and make the assessment of cardiac function of patients.