NT-proBNP、cTnI、H-FABP对呼吸困难鉴别诊断及预后判断的价值

Differential diagnostic and prognostic values of measurements of N-terminal pro-brain natriuretic peptide,cardiac troponin I and heart-type fatty acid binding protein in patients with dyspnea

目的:探讨氨基末端B型脑钠肽前体(Nterminal pro-brain natriuretic peptide,NT-pro BNP)、肌钙蛋白I(cardiac troponin I,c Tn I)、心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,HFABP)对呼吸困难患者的鉴别诊断以及预后判断的价值。方法:选择80名[其中男55例,女25例;平均年龄(53.5±7.8)岁]呼吸困难患者作为试验组和健康体检者20名[其中男14例,女6例,平均年龄(52.6±6.9)岁]作为对照组,测定其血清NT-pro BNP、c Tn I、H-FABP浓度,根据出院诊断将呼吸困难患者分为慢性收缩性心力衰竭(CHF)组和非慢性收缩性心力衰竭(NCHF)组,按纽约心脏病学会(NYHA)标准将CHF组又分为心功能Ⅱ、Ⅲ、Ⅳ级三个亚组。分别观察五组NT-pro BNP、c Tn I、H-FABP的水平并进行比较。随访观察患者心脏事件再发生的情况。结果:血清NT-pro BNP、c Tn I、H-FABP浓度在CHF各亚组均高于对照组和NCHF组(P<0.05),且心功能越差其浓度越高(P<0.05),而对照组和NCHF组之间差异无统计学意义(P>0.05)。NT-pro BNP、c Tn I、H-FABP联合检测诊断CHF的敏感性为93.6%、阴性预测值为95.6%,高于NT-pro BNP、c Tn I、H-FABP任何一项单独检测,差异有统计学意义(P<0.05)。随访患者发生心脏事件组血清NT-pro BNP、c Tn I和H-FABP出院时浓度明显高于未发生心脏事件组(P<0.01)。结论:联合检测NT-pro BNP、c Tn I和H-FABP对于诊断CHF和判断其病情严重程度及预后具有重要的意义,对于鉴别CHF和NCHF引起的呼吸困难有很高的临床价值。

AIM： To explore the differential diagnostic and prognostic values of measurements of Nterminal pro-brain natriuretic peptide（ NT-pro BNP）,cardiac troponin I（ c Tn I） and heart-type fatty acidbinding protein（ H-FABP） in patients with dyspnea.METHODS： Choice 80 patients [55 males and 25females; mean age（53. 5 ± 7. 8） years] with dyspnea as test group and 20 healthy persons [14 males and 6 females; mean age（ 52. 6 ± 6. 9） years] as control group,and the serum concentrations of NTpro BNP,c Tn I and H-FABP were detected,patients with dyspnea were divided into one group of chronic systolic heart failure（ CHF） and the other group of non chronic systolic heart failure（ NCHF） according to the hospital discharge diagnosis,the CHF group was divided into three subgroups of cardiac function Ⅱ,Ⅲ,Ⅳ according to the New York Heart Association（ NYHA） standard. NT-pro BNP,c Tn I and HFABP levels were observed and compared in the five groups. Patients were followed up to be observed the recurrence of cardiac events. RESULTS： The concentration of NT-pro BNP, c Tn I, H-FABP in the CHF group were higher than those in the control group and NCHF group（ P〈0. 05）,the cardiac function was worse with the increase of concentration（ P〈0.05）,while there was no significant difference between the control and NCHF group（ P〈0. 05）. The sensitivity of NT-pro BNP,c Tn I,HFABP three combined detection in the diagnosis of CHF was 93. 6%,and the negative predictive value was 95. 6%,which was higher than that of NT-pro BNP,c Tn I,H-FABP of any single detection, the difference was statistically significant（ P〈0. 05）.In the follow-up patients of the cardiac events group,serum NT-pro BNP,c Tn I and H-FABP concentrations at hospital discharge were markedly higher than those in the non-cardiac events group（ P〈0. 01）.CONCLUSION： There is important significance on diagnosis,prognosis and judging the severity for the detection of NT-pro BNP,c Tn I and H-FABP in patients with CHF. The levels of NT-pro BNP,c Tn I and H-FABP can possibly be used clinically in differentiating dyspnea of CHF from NCHF.