联合检测血清甲状旁腺激素和N端B型-脑利纳肽前体在诊断老年急性心衰患者中的应用价值

Joint Detection of Levels of Serum Parathyroid Hormone and N -terminal Type B -brain -peptide Precursor in the Diagnosis of Acute Heart Failure in the Elderly

目的探讨联合检测血清甲状旁腺激素（PTH）和N端B型-脑利纳肽前体（NT—proBNP）在诊断老年急性心力衰竭患者中的应用价值。方法选取2015年1月～2016年12月本院急诊、门诊首诊的100例老年急性心衰患者和健康查体中心100例老年健康者。心衰诊断标准符合《2016年欧洲心脏病学会急、慢性心力衰竭诊断和治疗指南》。用ELISA法检测两组血清PrrH、NT—proBNP，同时超声心动监测心脏血流动力学指标。分别计算出PTH和NT—proBNP各自的敏感度、特异度以及两者联合检测的敏感度、特异度。结果100例老年急性心衰患者根据左室射血分数（LVEF）分为三组：〈40％、40％～49％、≥50％，其血清PTH分别为（106．51±6．30）ng／L、（73．21±5．12）ng／L、（60．12±4．87）ng／L，而100例健康者血清PTH为（40．06±3．13）ng／L，两者之间相比有差异。以平均值PTH≥56．05ng／L为诊断标准，急性心衰在LVEF〈40％组别的敏感度、特异度分别为85．4％和77．2％，LVEF40％～49％组别的敏感度、特异度分别为77．3％和70．6％，LVEF≥50％组别的敏感度、特异度分别为76．8％和72．1％。其中LVEF〈40％、40％～49％、≥50％三组的血清NT—proBNP分别为（2123．32±10．17）pg／ml，（2018．78±11．03）pg／ml、（2001．02±9．51）pg／ml。100例健康者血清NT—proBNP（466．32±7．53）pg／ml，两者之间有统计差异。以NT—proBNP≥1500．00pg／ml为诊断标准，在LVEF〈40％时其敏感度、特异度分别为87．5％和83．7％，LVEF40％～49％时其敏感度、特异度分别为85．3％和85．2％，LVEF≥50％其敏感度、特异度分别为86．3％和81．5％。当两者联合检测在LVEF〈40％时其敏感度、特异度分别为89．6％和82．3％，LVEF40％～49％时其敏感度、特异度分别为87．1％和83．3％，LVEF〉150％其敏感度、特异度分别为86．4％和82．6％。敏感度、特异度在两者联检时与分别单测PTH和NT—proBNP比较均有统计学意义（P〈0．05）。结论血清PTH和NT—proBNP联合检测提高心衰实验室检查敏感性，并结合超声血流动力学指标可提高急性心衰诊断准确性。可有效判读临床结果并便于急诊分级系统管理，尤其是社区门诊监测中射血分数尚在代偿范围的心力衰竭患者，降低心衰漏诊和误诊。

Objective To explore the value of the detection of the levels about serum parathyroid hormone （PTH） and N - terminal type B - brain - peptide precursor （ NT - proBNP） in the diagnosis of heart function in the patients with acute heart failure （AHF）. Methods 100 Elderly patients with AHF and 100 healthy individuals from January in 2015 to December in 2016 who came to our hospital at the first time were collected. They met the standards of 2016 European society of cardiology guide for the diagnosis and treatment of acute and chronic heart failure diagnosis. Serum PTH and NT - proBNP levels in the two groups were detected by ELISA. The sensitivity and the specific degrees of the PTH and the NT - proBNP were calculated respectively. Results Left ventricular ejection fraction （LVEF） in 100 elderly patients with heart failure were 〈40%, 40% -49% and≥50% respectively. The serum PTH levels in these elderly patients were （96. 51 ±6. 30） ng/L, （73.05 ±6. 12） ng/L and （61.12 ±5.87） ng/L respectively. But the levels of the serum PTH in 100 healthy individuals were （44. 08 ±3, 23） ng/L. There was the difference between the two groups. As diagnostic criteria for the average PTH ≥56. 05 ng/L, the sensitivity and specific degrees in the patients with LVEF 〈 40% were 83.4% and 76. 3% respectively; the sensitivity and specific degrees in the patients with LVEF 40% -49% were 75.3% and 70. 1% respectively; the sensitivity and speciality rate in the patients with LVEF≥50% were 76. 3% and 75. 1% respectively; and the levels of NT - proBNP serum of the patients with LVEF 〈 40%, 40% ±49% and ≥ 50% were （2011.02 ±10. 51 ） pg/ml, （2123.32 ±11.17） pg/ml and （2008.78 ±12.03） pg/ml respectively. The levels of the serum NT - proBNP in 100 healthy persons were （576.43 ± 9. 23 ） pg/ml. There was the difference between the two groups. As diagnostic critetic for the NT - proBNP ≥ 1500. 00 pg/ml, the sensitivity and specific degrees in the patients with LVEF 〈40% were 85.3% and 80. 7% respectively; the sensitivity and specific degrees in the patients with LVEF 40% - 49% were 87.6% and 85. 1% respectively; the sensitivity and speciality rate in the patients with LVEF≥50% were 83.3% and 81.1% respectively. As the jont detection, the sensitivity and speciality in the patients with LVEF 〈 40% were 87.5% - 81.3% respectively; the sensitivity and specific degrees in the patients with LVEF 40% -49% were 88. 1% and 82. 1% respectively; the sensitivity and speciality rate in the patients with LVEF≥50% were 89.4% and 82. 3% respectively. There were different in the sensitivity and specific degrees as the joint inspection compared with PTH and NT - proBNP （P 〈 0. 05）. Conclusion The joint detection of PTH and NT - proBNP combined with ultrasonic cardiogram have clinical significance in the diagnosis of AHF.