中性肽链内切酶对心衰所致胸腔积液的诊断价值

Diagnostic value of neutral endotryptase in heart faliure-related pleural effusion

目的探讨胸腔积液中性肽链内切酶(neprilysin,NEP)浓度变化及其对心衰所致胸腔积液的诊断价值。方法 88例胸腔积液住院患者纳入研究,根据病因分为心衰组胸腔积液25例,类肺炎组胸腔积液21例,结核组胸腔积液21例及肿瘤组胸腔积液21例,酶联免疫吸附法测定胸腔积液NEP浓度。结果 (1)心衰组NEP浓度显著低于其他组(P<0.001),类肺炎组和肿瘤组NEP浓度无显著差异(P>0.05),均显著低于结核组(P<0.001)。(2)胸腔积液中NEP浓度和血清脑钠肽(brain natriuretic peptide,BNP)含量呈负相关(r=-0.570,P<0.001)。(3)ROC曲线显示NEP浓度271 pg/mL为临界值诊断心衰所致胸腔积液灵敏度为76%,特异度为92.06%。胸腔积液NEP联合血清BNP诊断心衰所致胸腔积液灵敏度为98.1%,特异度为98.4%。结论心衰所致胸腔积液中NEP分泌降低,对诊断心衰有一定参考价值;胸腔积液NEP联合血清BNP可提高心衰诊断的灵敏度和特异度。

Objective To investigate the change of neutral endotryptase （NEP） and evaluate the diagnostic value of NEP in pleural effusion. Methods 88 cases of pleural effusion inpatients were enrolled in the study. Pleu- ral effusion was categorized as heart failure-related pleural effusion （HF, n = 25）, parapneumonic pleural effusion （PPE, n =21）, tuberculous effusion （TE, n =21） and malignant pleural effusion （MPE, n =21） based on the etiology. The NEP concentration of pleural effusion was measured by enzyme-linked immunosorbent assay method. Re- suits NEP concentration in the HF group was significantly lower than in the other three groups （P 〈 0. 001 ）. There was no significant difference in NEP concentration between the PPE group and the MPE group （ P 〉 0.05 ） , but it was lower than that in the TPE group （ P 〈 0. 001 ）. The NEP level of pleural effusion exhibited a positive correlation with brain natriuretic peptide （BNP） in serum （ r = 0. 570, P 〈 O. 001 ）. The optimal cutoff value of 271 pg/mL was found to predict HF with a diagnostic sensitivity of 76. 0% and specificity of 92. 0% in pleural effusion. The NEP of pleural effusion in combination with serum BNP could gain a higher sensitivity of 98.1% in parallel test and a higher specificity of 98.4% in serial test. Conclusion The detection of NEP concentration in pleural effusion is informative for the diagnosis of HF. Joint detection of NEP in pleural effusion and serum BNP could improve the diagnostic sensi- tivity and specificity.