NT—proBNP结合UCG检查对老年人心功能评估的临床价值

Clinical Value of NT-proBNP Combined UCG for Assessing Cardiac Function in Aged People

【目的】探讨老年人血浆NT—proBNP与心功能的关系，并进一步鉴别是结构性还是功能性异常。【方法】对92例85岁以上老人进行超声心动图（UCG）检查，并抽取其静脉血进行血浆NT—proBNP浓度测定，用线性回归分析NT-proBNP与心功能异常的关系、用ROC曲线分析NT—proBNP诊断心功能异常的准确性。【结果】UCG异常组的NT—proBNP水平显著高于正常组（P〈O．01）；回归分析表明，左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室舒张早期二尖瓣流入速度E峰与舒张晚期二尖瓣流入速度A峰的比值（E／A）、左房容积（LAV）、肺动脉压（PAP）、二尖瓣和主动脉瓣关闭不全的严重程度为NTproBNP水平的独立影响因子；NT—proBNP排除任-UCG参数异常的R0c曲线下面积（AUC）为0．8l（95％c10．71～0．87）；若以273．5pg／mL为NTproBNP的诊断临界值，则其灵敏度为85．5％，阴性预期值为83．8％。以这一临界值排除PAP、左室舒张和（或）收缩功能不全以及左室肥厚的灵敏度、特异性、阳性和阴性预期值分别为86．5％、49．1％、53．3％和84．4％。【结论】在85岁以上老人，NT—proBNP升高与多种功能性和结构性心功能异常有关。NT—proBNP可用来排除UCG异常以及提示是否需要进行进一步心血管检查。

[Objective] To explore the relationship between plasma NT-proBNP and cardiac function in aged people and to further distinguish structural and functional cardiac dysfunction. [Methods] Ultrasonic eardiogram（UCG） was performed in 92 aged people more than 85 years old. The venous blood was drawn to measure plasma NT-proBNP level. Linear regression analysis was used to study the relationship between NT- proBNP and cardiac abnormalities. ROC curve analysis was used to assess the accuracy of NT-proBNP for the diagnosis of cardiac abnormalities. [Results] NT-proBNP level in the abnormal UCG group was significantly higher than that in normal UCG group（P〈0.01）. Regression analysis showed that left ventricular end-diastolic diameter （LVEDD）, left ventricular end-systolic diameter （LVESD）, E/A ratio, left atrial volume （LAV）, pulmonary artery pressure（PAP） and the severity of mitral and aortic incompetence were the inde pendent influential factors of NT proBNP. Area under eurve（AUC） of ROC of NT proBNP to exclude any abnormal UCG was 0.81（95% CI 0. 71-0. 87）. If the diagnostic critical value of NT-proBNP was 273.5pg/mL, its sensitivity was 85.5% and negative predictive value was 83.8%. If the critical value of NT proBNP was used to exclude PAP, left ventricular diastolic or systolic dysfunction and left ventricular hypertrophy, its sen sitivity, specificity, positive and predictive value were 86. 5%, 49. 1%, 53. 3% and 84. 4%, respectively. [Conclusion] The increasing of NT proBNP in aged people more than 85 years old is related to many kinds of functional and structural cardiac abnormalities. NT proBNP can be used to exclude UCG abnormalities and in dicates who needs to be referred for further cardiovascular examination.