心房颤动对NT-proBNP诊断急性心力衰竭的影响

Influence of atrial fibrillation on NT-proBNP for diagnosing acute heart failure

目的：分析心房颤动（AF）对氨基末端脑钠肽前体（NT‐proBNP）用于诊断急性心力衰竭（AHF）的影响。方法收集因急性呼吸困难住院疑诊 AHF 并于入院24 h 内行 NT‐proBNP 检测和心电图检查的患者457例，根据是否确诊 AHF 及入院心电图是否合并 AF 分组，AHF 合并 AF（AHF ＋ AF）组65例；AHF 不合并 AF（AHF ＋ non AF）组50例；非 AHF 合并 AF（non AHF ＋ AF）组63例；非 AHF 不合并 AF（non AHF ＋ non AF）组10例。用受试者工作特征曲线（ROC 曲线）评估 NT‐proBNP 诊断 AHF 的价值。结果457患者中，确诊 AHF 者194例（42．5％），AF 者140例（30．6％）。 AF 组 NT‐proBNP 水平显著高于non AF 组（4482．0 pg／mL vs ．1302．0 pg／mL ，P＜0．01），AHF ＋ AF 组与 AHF ＋ non AF 组 NT‐proBNP 水平差异无统计学意义（6580．0 pg／mL vs ．6769．0 pg／mL ，P ＞0．05），non AHF ＋ AF 组 NT‐proBNP 水平较 non AHF ＋ non AF 组显著升高（2892．0 pg／mL vs ．403．3 pg／mL ，P＜0．01）。 AF 组与 Non AF 组 NT‐proBNP 诊断 AHF 的曲线下面积分别为0．759（95％ CI ：0．677～0．841，P＜0．01），0．931（95％ CI ：0．903～0．985，P＜0．01）。结论 NT‐proBNP 水平在非急性心力衰竭的房颤者中显著升高，可能影响其在 AHF 中的诊断价值，临床应用时，为更好地解读 NT‐proBNP 结果，需注意患者是否为房颤心律。

Objective To analyze the influence of atrial fibrillation（AF） on N‐terminal pro‐brain natriuretic peptide（NT‐proB‐NP） for the assist diagnosis of acute heart failure（AHF） .Methods Totally 457 inpatients with suspected AHF due to acute dysp‐nea and conducting blood NT‐proBNP detection and electrocardiogram（ECG） within 24 h of admission were collected and devided into groups according to whether AHF was diagnosed and complicated with AF identified by ECG on admission ,that was AHF ＋AF group ,AHF ＋ non AF group ,non AHF ＋ AF group ,non AHF ＋ non AF group .The receiver operating characteristic （ROC） curve was adopted to evaluate the value of NT‐proBNP for diagnosing AHF .Results Among 457 cases ,194 cases （42 .5% ） were diagnosed as AHF and 140 cases （42 .5% ） as AF .The NT‐proBNP level in the AF group was significantly higher than that in the non AF group （4 482 .0 pg/mL vs .1 302 .0 pg/mL ,P 〈 0 .01） .The NT‐proBNP level had no statistical difference between the AHF ＋ AF group and the AHF ＋ non AF group AF（6 580 .0 pg/mL vs .6 769 .0 pg/mL ,P〉 0 .05） .The NT‐proBNP level in the non AHF ＋ AF group was significantly increased compared with the non AHF ＋ non AF group （403 .3 pg/mL vs .2 892 .0 pg/mL ,P〈 0 .01） .The area under the curve（AUC） of NT‐proBNP for diagnosing AHF in the AF group and the non AF group was 0 .759（95% CI ：0 .677 - 0 .841 ,P 〈 0 .01） and 0 .931（95% CI ：0 .903 - 0 .985 ,P 〈 0 .01） .Conclusion The NT‐proBNP level in AF patients without AHF is significantly increased ,which might affect the value of NT‐proBNP in the diagnosis of AHF .In the clinical applica‐tion ,whether the patient has AF cardiac rhythm should be paid attention to for better interpretating the detection result of NT‐proBNP .