B型利钠肽在慢性心力衰竭诊断中的应用价值研究

Diagnostic Value of BNP on Chronic Cardiac Failure

目的：探讨B型利钠肽（ BNP）在慢性心力衰竭（ CHF）诊断中的应用价值。方法选择2011年1月—2013年7月阜南县人民医院门诊和住院CHF患者260例，按照纽约心脏协会（ NYHA）心功能分级将患者分为心功能Ⅱ级组94例、心功能Ⅲ级组112例、心功能Ⅳ级组54例，另选择同期体检中心体检健康者60例作为空白组。比较各组受试者血清BNP水平和左心室射血分数（ LVEF），分析CHF患者血清BNP水平与LVEF的相关性，并绘制血清BNP水平诊断CHF的受试者特征（ ROC）曲线。结果血清BNP水平为心功能Ⅳ级组﹥心功能Ⅲ级组﹥心功能Ⅱ级组﹥空白组，LVEF为心功能Ⅳ级组﹤心功能Ⅲ级组﹤心功能Ⅱ级组﹤空白组（P﹤0.05）。Xpearman等级相关分析结果显示，CHF患者血清BNP水平与LVEF呈负相关（r＝-0.72，P﹤0.01）。以CHF患者血清BNP水平绘制ROC曲线，ROC曲线下面积（AUC）为0.966〔95％CI（0.935~1.010）〕，以98.6 ng/L作为CHF的诊断界值时其灵敏度为92.7％、特异度为94.5％、准确度为93.0％。结论 BNP诊断CHF具有较高的灵敏度、特异度及准确度，且安全、快捷、可靠，具有一定的临床应用价值。

Objective To explore the diagnostic value of BNP on chronic heart failure（ CHF）. Methods A total of 260 CHF patients were selected in the People＇s Hospital of Funan County from January 2011 to July 2013,and they were divided into three subgroups according to New York Heart Association（ NYHA） cardiac function grading：A group（ grading atⅡ,n=94）,B group（grading at Ⅲ,n =112）,C group（grading at Ⅳ,n =54）;a total of 60 healthy cases were selected as control group. Xerum BNP level and LVEF of each group were compared,and the correlation between them was analyzed,ROC curve was draw to evaluate the diagnostic value of BNP on CHF. Results The serum BNP level of C group was higher than that of B group,that of B group was higher than that of A group,and that of A group was higher than that of control group（ P﹤0. 05）;while LVEF of C group was lower than that of B group,that of B group was lower than that of A group,and that of A group was lower than that of control group（P﹤0. 05）. Xpearman rank correlation analysis showed that,serum BNP level of CHF patients was negatively correlated with LVEF（r= -0. 72,P﹤0. 01）. ROC curve showed that,the AUC of serum BNP level to diagnose CHF was 0. 966〔95%CI（0. 935,1. 010）〕,and the best threshold was 98. 6 ng/L,the sensitivity was 92. 7%,specificity was 94. 5%,accuracy was 93. 0%. Conclusion BNP has certain diagnostic value on CHF,is with high sensitivity,specificity and accuracy,and its detection is safe,fast and reliable.