床边检测N-末端脑利钠肽前体对心力衰竭的诊断价值

Diagnostic value of bedside immediate detecting plasma N terminal-pro brain natriuretic peptide in patients with congestive heart failure

目的:探讨床边即时检测血浆N-末端脑利钠肽前体(NT-proBNP)浓度对充血性心力衰竭患者的诊断价值。方法:入选60例充血性心力衰竭(心衰组)及20例非心力衰竭患者(非心衰组)。根据NYHA心功能分级,心衰组又分为心功能Ⅱ、Ⅲ、Ⅳ级组;按左室射血分数(LVEF)将心衰组分为LVEF<40%组和≥40%组。测定所有研究对象的血浆NT-proBNP水平,LVEF和左室舒张末内径(LVEDd)。结果:(1)心衰组患者血浆NT-proBNP水平明显高于非心衰组患者[(2365±86)ng/L比(46±7)ng/L,P<0.01],心功能Ⅲ、Ⅳ级组NT-proBNP水平明显高于Ⅱ级组[(3069±96)ng/L、(3850±75)ng/L比(1056±82)ng/L,P<0.01];(2)LVEF<40%组的NT-proBNP显著高于≥40%组[(3456±71)ng/L比(585±35)ng/L,P<0.01];(3)如以400ng/L为正常参考值,NT-proBNP诊断心衰的敏感性为91.8%,特异性为93.6%;(4)心衰患者NT-proBNP水平与LVEDd呈正相关(r=0.736,P<0.01),与LVEF呈负相关(r=-0.68,P<0.05)。结论:床边即时检测血浆N-末端脑利钠肽前体对诊断心衰敏感而且特异,可作为心衰诊断的一个客观指标。

Objective： To study diagnostic value of bedside immediate detection of plasma N terminal--pro brain natri- uretic protein （NT--proBNP） in patients with congestive heart failure （CHF）. Methods.. A total of 60 CHF patients （CHF group） and 20 non-CHF patients （non-CHF group） were enrolled. According to NYHA cardiac function classification, CHF group was divided into NYHA cardiac function class Ⅱ, Ⅲ and Ⅳ groups; according to left ventricular ejection fraction （LVEF）, CHF group was divided into LVEF〈40% group and ILVEF40% group. Plasma level of NT-proBNP, LVEF and left ventricular end--diastolic dimension （LVEDd） were measured and compared among different groups. Results： （1） Plasma level of NT--proBNP in CHF group was significantly higher than that of non-CHF group [ （2365±86） ng/L vs. （46±7） ng/L, P〈0.01], and NT--proBNP levels in NYHA cardiac function class m and IV groups were significantly higher than that of NYHA cardiac function class Ⅱ group [ （3069 ±96） ng/L, （3850±75） ng/L vs. （1056±82） ng/L, P〈0.01]; （2） NT--proBNP level of LVEF〈40% group was significantly increased than that of LVEF±40% group [ （3456±71） ng/L vs. （585±35） ng/L, P〈0.01]; （3） When 400 ng/L was regard as normal reference value, sensitivity and specificity of NT--proBNP in diagnosing CHF were 91.8% and 93.6% respectively; （4） NT--proBNP level was positively correlated with LVEDd （r=0. 736, P 〈0.01）, and negatively correlated with LVEF （r=-0.68, P〈0.05）. Conclusion： Bedside immediate detection of plasma NTproBNP is sensitive and specific in diagnosing CHF and can be regard as an objective indicator for diagnosis of CHF.