N-末端脑钠肽前体在老年人肺血栓栓塞症和心力衰竭中的应用价值

The diagnostic role of N-terminal brain natriuretic peptide in identifying acute pulmonary thromboembolism versus congestive heart failure in dyspnea patients

目的探讨N-末端脑钠肽前体（NT-proBNP）在以急性呼吸困难为主要临床表现的急性肺血栓栓塞症（APE）和充血性心力衰竭（CHF）中的鉴别诊断价值。方法收集2010年6月至2015年10月260例因急性呼吸困难就诊于我院的疑诊为APE或CHF的老年患者，根据诊断标准分别入选APE组和CHF组，比较两组患者血清NT-proBNP水平差异，并通过绘制受试者工作特征曲线（ROC）分析NT-proBNP对APE的诊断价值。结果APE组NT-proBNP水平明显低于CHF组[（2 478.8±1 473.9）ng/L比（5 955.4±3 180.1）ng/L，t＝－12.020，P〈0.01]。根据ROC曲线得出，NT-proBNP取临界值为1 518.5 ng/L时，其诊断APE的特异度高达98.8%，ROC曲线下面积为0.877。结论对于因急性呼吸困难就诊的APE和CHF患者，NT-proBNP作为简单、经济、快速且床旁进行的检查手段，可协助临床医师早期识别APE，降低APE的漏诊率和误诊率。

ObjectiveTo explore the role of NT-proBNP in the differentiation of acute pulmonary embolism （APE） from congestive heart failure （CHF） in patients with acute dyspnea.MethodsConsecutive 260 patients aged ≥ 60 years complaining of acute dyspnea were collected between June 2010 and October 2015.The patients were divided into two groups of APE and CHF according to their diagnosis standards.The levels of NT-proBNP between the two groups were compared using t-test, and receiver operating characteristic curve （ROC curve） was made to show the value of NT-proBNP in differentiation of APE from CHF.ResultsPatients in APE group had significantly lower median levels of NT-proBNP as compared with patients in CHF group [（2 478.8±1 473.9）ng/L vs.（5 955.4±3 180.1）ng/L, t=-12.020, P〈0.01]. The ROC curve of APE existence against serum levels of NT-proBNP showed an optimal cut-point of NT-proBNP of 1 518 ng/L, with specificity up to 98.8%, and the area under the ROC curve for NT-proBNP was 0.877.ConclusionsNT-proBNP as a simple and bedside approach to identify APE versus CHF patients with acute dyspnea can help clinicians identify APE early and reduce the rates of misdiagnosis and missed diagnosis of APE.But the confirmative diagnosis of APE is still based on spiral CT angiography.