血浆B型利钠肽前体对老年患者呼吸困难病因的鉴别诊断价值

Differential diagnosis value of etiology plasma brain natriureticin peptide in aged patients with dyspnea

目的探讨B型利钠肽前体(pro-B-type brain natriureticin peptide,pro-BNP)对老年患者呼吸困难病因的鉴别诊断价值。方法共入选因急性呼吸困难入院的老年患者60例(已明确诊断心力衰竭的除外),采用荧光免疫法快速测定血浆pro-BNP水平,采用超声心动图测定左室射血分数,采用右心漂浮导管法测定肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)。结果①急性心力衰竭患者血浆pro-BNP水平明显高于非心力衰竭患者[(665±58)vs(46±3)ng/L,P<0.01];②pro-BNP以100 ng/L为正常参考值,pro-BNP诊断心力衰竭的敏感性为93.6%,特异性94.3%,排除心力衰竭的阴性预测值93.4%;③心力衰竭患者pro-BNP水平与PCWP呈正相关(r=0.43,P<0.01),与LVEF呈负相关(r=-0.67,P<0.01)。结论荧光免疫法即时检测血浆pro-BNP水平对老年呼吸困难患者的病因鉴别诊断具有重要预测价值。

Objective： To investigate differential diagnosis value of etiology of pro-B-type brain natriuretic peptide（pro-BNP） in aged patients with dyspnea.Methods： Plasma BNP concentrations were rapidly measured with immunofluorescence assay in 60 aged patients with dyspnea in hospital.Left ventricular ejection fraction（LVEF） and pulmonary capillary wedge pressure（PCWP） were determined by echocardiography and right mind float packing method in these patients at the same time respectively.Results：（1） Plasma pro-BNP levels in the patients with acute heart failure were significantly higher than those in the non-heart failure patients（[665±58]vsng/L,P0.01）.（2） The sensitivity,specificity and negative predictive values of plasma pro-BNP levels≥100ng/ L for diagnosing acute heart failure were 93.6%,94.3 % and 93.4% respectively.（3） Plasma pro-BNP levels were positively and significantly related to PCWP,and negatively related to LVEF（r =0.43 and r =-0.67,both P 0.01）.Conclusion： Plasma pro-BNP concentration rapid measured with immunofluorescence assay is differential diagnosis value of etiology for predicting dyspnea in aged patients.