B型钠尿肽对老年无症状舒张功能不全患者诊断价值的分析

Value of serum B-natriuretic peptide for the diagnosis of asymptomatic diastolic dysfunction in the elderly

目的探讨老年无症状舒张功能不全(ADD)患者血清B型钠尿肽(BNP)水平变化及血清BNP对该疾病的诊断价值。方法选取157例老年ADD患者(ADD组)及89例健康老年人(对照组),采用微粒子酶联免疫法测定血清BNP水平,超声心动图测定LVEF、二尖瓣舒张早期血流峰值(E)/舒张晚期血流峰值(A)、E/左心室舒张早期血流播散速度(Vp)等指标。结果与对照组比较,ADD组患者BNP水平明显升高(P<0.01),BNP中位数水平明显高于对照组(95.38 ng/Lυs 52.52 ng/L,P<0.01)。BNP与E峰减速时间(r=0.39,P<0.05)、E/Vp呈正相关(r=0.29,P<0.05),与PVs/PVd、E/A无相关性(r=0.18,r=0.14,P>0.05)。ROC曲线分析显示,BNP诊断老年ADD的诊断界值为90.06 ng/L,此时诊断老年ADD的敏感性和特异性分别为55%和94%;ROC曲线下面积为0.771。结论老年ADD患者血清BNP水平升高,BNP尚不能作为诊断指标在人群中筛查老年ADD患者的存在,但BNP水平正常可排除老年ADD的诊断。

Objective To study the value of serum B-natriuretic peptide（BNP） for the diagnosis of asymptomatic diastolic dysfunction（ADD） in the elderly.Methods One hundred and fifty-seven elderly ADD patients served as ADD group and 89 healthy old volunteers served as control group.Their serum BNP levels were measured by sandwich ELISA and their LVEF,E/A,E/Vp were detected by echocardiography.Results The serum BNP level was significantly higher in ADD group than in control group（95.38 ng/L vs 52.52 ng/L,P〈0.01） and positively related with DT and E/Vp（r=0.39 and 0.29,P〈0.05） but not with PVs/PVd and E/A（r=0.18 and 0.14,P〉0.05）.ROC curve analysis showed that the sensitivity and specificity of BNP were 55% and 94% respectively when its cutoff value was 90.06 ng/L for the diagnosis of ADD in the elderly.The area under the ROC curve was 0.771.Conclusion The serum level of BNP is rather high in elderly ADD patients and cannot be used as a diagnostic indication for ADD in the elderly,but ADD in the elderly can be excluded when their serum BNP level is normal.