血浆BNP对呼吸困难病因鉴别诊断的价值

The value of plasma BNP in differential diagnosis of dyspnea etiology

目的探讨血浆B型利钠肽(BNP)的测定在呼吸困难病因鉴别诊断中的价值。方法对178例因呼吸困难住院的患者,根据基础疾病、血气分析、肺动脉压力、左心室射血分数(LVEF)、左心室舒张功能等资料分成4组。比较各组血浆BNP水平,再于上述4组内按有无左心室舒张功能不全分为a、b两个亚组,比较两个亚组间的血浆BNP水平。结果 LVEF<40%的1组及2组血浆BNP显著高于LVEF≥40%的3组及4组(P<0.05)。以ROC曲线确定血BNP138.5 ng/L,预测左心室收缩功能不全敏感性为97.7%,特异性为77.2%。各组内有舒张功能不全的亚组其BNP水平显著高于无舒张功能不全的亚组(P<0.05)。结论血浆BNP在呼吸困难病因鉴别诊断中有重要价值。根据血浆BNP测定值结合患者基础疾病及心电图、血气、胸片等情况,临床医师可以比较快速的确定呼吸困难的病因,为抢救、治疗赢得宝贵的时间。

Objective To explore and discuss the value of BNP in differential diagnosis of dyspnea etiology.Method 178 dyspnea patients were divided into four groups based on to their background disease,blood gas analysis,pulmonary artery pressure,Left ventricular ejection fraction（LVEF） and left ventricular diastolic function etc.The figure of BNP was compared between the four groups.Each group was further divided into two subgroups,A B,based on whether or not the patients had left ventricular diastolic dysfunction.The figure of BNP was then compared between the subgroups.Results The plasma BNP of Group 1 and 2 whose（LVEF40%） was significantly higher than Group 3 and 4（LVEF≥40%）： P0.05.Defining BNP138.5 ng/L by ROC,the sensitivity of left ventricular systolic dysfunction was predicted as 97.7%,and the specificity as 77.2%.The BNP figure of the subgroups with diastolic dysfunction was significantly higher than the subgroup without diastolic dysfunction（P0.05）.Conclusions BNP is essential in differential diagnosis of dyspnea etiology.Clinical physicians may make quick and accurate diagnoses on dyspnea epitology according to BNP combining with patients＇ background disease,ECG,blood gas and chest X-ray etc.This is expected to win valuable time on resuscitation and treatment.