N末端脑钠肽在心源性与肺源性呼吸困难诊断中的应用价值

The Value of N-Terminal Brain Natriuretic Peptide in the Diagnosis of Cardiac and Pulmonary Dyspnea

目的探讨N末端脑钠肽(NT-proBNP)在心源性与肺源性呼吸困难诊断及鉴别诊断中的应用价值。方法根据临床诊断分心源性呼吸困难组(543例)与肺源性呼吸困难组(484例)。采用双向侧流免疫法测定两组患者血浆NT-proBNP水平;对比分析心源性呼吸困难组不同病因、不同心功能亚组间血浆NT-proBNP水平;肺源性呼吸困难组不同肺功能亚组间血浆NT-proBNP水平。结果心源性呼吸困难组血浆NT-proBNP水平(5163 pg/ml)显著高于肺源性呼吸困难组(496pg/ml),P<O.OO1;在心源性呼吸困难患者中,病因不同其血浆的NT-proBNP水平升高不同(3905.5-9379 pg/ml),P=0.001;有并发症患者NT-proBNP水平(5615.4 pg/ml)显著高于无并发症患者(4459.2 pg/ml),P<0.05,且血浆NT-proBNP水平与心功能NYHA分级呈正相关(r=0.2826,p<0.001),与左室射血分数呈负相关(r=-0.3145,p<0.001)。在肺源性呼吸困难患者中,有呼吸衰竭患者血浆NT-proBNP水平(2847.67pg/ml)明显高于无呼吸衰竭患者(373.96pg/ml),p<0.001;合并左心功能不全患者血浆NT-proBNP水平(2265pg/ml)明显高于无呼吸衰竭的患者(373.96pg/ml),p<0.001。结论 NTproBNP可作为鉴别心源性及肺源性呼吸困难的特异性指标;心源性呼吸困难病因中扩张型心肌病患者血浆NT-proBNP水平升高最明显;血浆NT-proBNP水平可作为心源性呼吸困难患者病情预后评估指标;肺源性呼吸困难患者血浆NT-proBNP水平异常升高提示合并有呼吸衰竭。

Objective To investigate the value of N-terminal brain natriuretic peptide（NT-proBNP） in the diagnosis and differential diagnosis of cardiac and pulmonary dyspnea. Methods According to the clinical diagnosis, the patients were divided into cardiac dyspnea group（543 cases） and pulmonary dyspnea group（484 cases）. The plasma NT-proBNP levels of the patients in two groups were detected by using bi- lateral flow immunoassay method; In subgroup analysis, the plasma NT-proBNP levels among etiology and heart function subgroups of the cardiac dyspnea patients as well as the pulmonary function subgroup of pulmonary dyspnea patients were compared. Results The plasma NT-proBNP levels in cardiac dyspnea group（5163 pg / ml） were significantly higher compared with pulmonary dyspnea group（496pg/ml）, P 0.001;The patients with cardiac dyspnea presented different elevated levels of plasma NT-proBNP according to various causes（3905.5 ~ 9379 pg / ml）, P = 0.001; NT-proBNP levels in patients with complications（5615.4 pg / ml） were significantly higher than in patients without complications（4459.2 pg / ml）, P 0.05.Meanwhile, NT-proBNP levels were positively correlated with NYHA class（r = 0.2826, p 0.001）, and negatively associated with left ventricular ejection fraction（r =-0.3145, p 0.001）. In the pulmonary dyspnea group, plasma NT-proBNP levels in patients with respiratory failure（2847.67pg/ml） were significantly higher than those without respiratory failure（373.96pg/ml）, p 0.001; the plasma NT-proBNP levels in patients combined with left ventricular dysfunction（2265pg/ml） were significantly higher than in patients without respiratory failure（373.96pg/ml）, p 0.001. Conclusions NT-proBNP can be used as a specific indicator in identification of cardiac and pulmonary dyspnea; In all causes of cardiac dyspnea, dilated cardiomyopathy patients showed the most obvious elevated plasma NT-proBNP levels; Plasma NTproBNP levels can be as an indicator to evaluate the prognosis of patients with pulmonary dyspnea; The abnormally elevated NT-proBNP levels in patients with pulmonary dyspnea prompt complication of respiratory failure.