血清脑钠肽检测在老年人甲状腺功能亢进性心脏病中的诊断价值

Diagnostic value of detection of plasma B-type natriuretic peptide in elderly patients with hyperthyroid heart disease

目的探讨血清脑钠肽检测在老年人甲状腺功能亢进性心脏病中的诊断价值。方法随机选取2014年11月至2015年10月收治的首次确诊或复发尚未行任何治疗的甲亢老年患者72例,分为甲状腺功能亢进性心脏病组(36例)、单纯甲状腺功能亢进组(36例),同时32名健康体检者作为对照组,采用酶联免疫吸附试验(ELISA)对比3组血清脑钠肽(BNP)水平,心脏超声检查检查3组的左心室收缩末期左心房前后径(LAD)、舒张末期左心室内径(LVEDD)和左心室射血分数(LVEF)。结果甲亢患者2组老年患者的BNP水平明显高于对照组,且甲亢心脏病组比单纯甲亢组水平要高(P<0.01);甲亢患者的LAD、LVEDD明显高于对照组,甲亢心脏病组比单纯甲亢组更高(P<0.001),3组LVEF无显著差异(P=0.329)。BNP水平与LVEF呈显著负相关(R=-0.743,P=0.001),与LAD和LVEDD呈正相关(R=0.823,0.726);清BNP水平预测甲亢心脏病的ROC曲线下面积为0.914(P<0.05),其临界值为283.65 pg/ml时,灵敏度为94.8%,特异度为91.3%。结论血清脑钠肽的检测可作为是老年甲状腺功能亢进性心脏病的早期诊断标准。

Objective To explore the diagnostic value of detection of plasma B-type natriuretic peptide （ BNP） in elderly patients with hyperthyroid heart disease .Methods Seventy -two elderly patients with hyperthyroidism who were admitted and treated in our hospital from November 2014 to October 2015 were divided into hyperthyroid heart disease group （n=36） and simple hyperthyroidism group （ n =36）,meanwhile 32 healthy subjects were served as control group .The serum levels of B-type natriuretic peptide were detected by enzyme-linked immunosorbent assay （ ELISA ） , and left atrial diameter （LAD）, left ventricular end diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF） were detcted by heart ultrasonography .Results The serum levels of BNP in hyperthyroid heart disease group and simple hyperthyroidism group were significantly higher than those in control group , moreover, which in hyperthyroid heart disease group were significantly higher than those in simple hyperthyroidism group （ P 〈0.01）.The LAD and LVEDD in simple hyperthyroidism group were significantly higher than those in control group , moreover, which in hyperthyroid heart disease group were significantly higher than those in simple hyperthyroidism group （ P 〈0.01）.However there was no significat difference in LVEF among the three groups （ P 〉0.05）.The levels of BNP were negatively correlated to those of LVEF ,however,which were positively correlated with those of LAD and LVEDD .The area under ROC curve by BNP levels predicting hyperthyroid heart disease was 0.914 （ P 〈0.05）,and its critical value was 283.65pg/ml, and sensitivity and specificity were 94.8%, 91.3%,respectively.Conclusion The detection of serum levels of B-type natriuretic peptide can be regarded as an early diagnostic criteria for hyperthyroid heart disease in the elderly .