NT-proBNP和cTnI联合检测在心力衰竭早期诊断中的临床意义

Clinical Application Value of Combinted Detection of NT-proBNP and CTnI in the Early Diagnosis of Heart Failure

目的探讨全血氨基末端B型钠尿肽前体(N-terminal B type natriuretic peptide precursor,NT-proBNP)和心肌肌钙蛋白I(cardiac troponin I,cTnI)二者联合检测在心力衰竭(heart failure,HF)早期诊断中的临床意义。方法检测174例明确诊断为HF患者(病例组I),120例经诊断未有HF的冠心病、高血压等其他患者(病例组II),200例健康体检人群(对照组)的NT-proBNP和cTnI的浓度。分析三组人群的血液中NT-proBNP和cTnI水平差异以及NT-proBNP和cTnI两项指标联合检测的诊断价值,并随访观察患者(病例组I和II)死亡及心衰再入院事件的发生。结果病例组I全血中NT-proBNP和cTnI分别为3765.00±1765.34ng/L、0.029±0.012μg/L,病例组II全血中NT-proBNP和cTnI分别为778.5±354.33ng/L、cTnI为0.018±0.011μg/L,病例组I的NT-proBNP和cTnI分别明显高于病例组II且有统计学意义(p<0.05),对照组NT-proBNP为105.5±68.21ng/L、cTnI为0.010±0.002μg/L。和对照组相比,病例组I和病例组II中NT-proBNP和cTnI浓度均有升高。联合检测平行(并联)试验对心力衰竭诊断的敏感性和特异性分别为83.91%和99.06%。随访结果提示,NT-proBNP和cTnI联合检测分组间的患者死亡率或因心衰再入院率有显著性差异(Logrank test,p<0.05)。结论联合检测NT-proBNP和cTnI对心力衰竭的早期筛查和诊断具有一定的临床应用价值。

Objective To investigate the whole blood N-terminal B type natriuretic peptide precursor （NT-proBNP） and cardiac troponin I （cTnI） two combined detection in heart failure （HF） in the early diagnosis. Methods Comparison of NT-proBNP and cTnI diagnostic value for 174 cases diagnosed I-IF patients （case group I）, 120 cases subjects with coronary heart disease（CHD） or hypertension without HF （case group Ⅱ） and 200 healthy subjects （control group）. Patients were followed up to observe death and rehospitalization events. Results The case group I NT-proBNP and cTnI were 3765.00±1765.34ng/ L, 0.029±0.012μg/L, the case group Ⅱ were 778.5±354.33ng/L, 0.018±0.011 μg/L, while the control group were 105.5±68.21ng/L, 0.010±0.002μg/L.The NT- proBNP and cTnI for case group I was larger than case group II and control group with significant difference（p〈0.05）. The combined detection of NT-proBNP and cTnI （parallel） parallel test＇s sensitivity and specificity were 83.91% and 99.06%. The follow up results showed that there was singnificant difference for death and/or rehospitalization events rate, between NT-proBNP and cTnI combined detection groups（Logrank test, p〈0.05）. Conclusion The combined detection of NT-proBNP and cTnI has valuable significance in the early diagnosis of HF. The combined detection of NT-proBNP and cTnI has certain reference value in exclusion of HF patients and to reduce the occurrence of misdiagnosis.