NT-Pro BNP对AECOPD患者合并心功能不全诊断意义研究

Diagnostic Significance of NT-Pro BNP in Diagnosis of AECOPD Patients with Cardiac Insufficiency

目的观察氨基末端脑钠肽前体(NT-Pro BNP)在慢性阻塞性肺疾病伴有急性加重患者(chronic obstructive pulmonary disease,COPD)合并心功能不全患者的变化情况,并探寻最佳判断临界值。方法回顾性分析2015年1月—2016年12月该院肺炎患者140例,其中AECOPD合并心功能不全患者70例,普通AECOPD患者70例,进行NT-pro BNP,用SPSS 17.0比较两组患者年龄、性别、病程等一般资料,以中华医学会COPD诊断标准及心功能不全诊断表标准作为标准计算NT-Pro BNP对应分值的敏感度、特异度、阳性似然比、阴性似然比、诊断比值比,Youden指数,绘制ROC曲线,计算曲线下面积,并寻找最佳诊断值。结果两组患者年龄、性别、病程等一般情况差异无统计学意义(P>0.05),AECOPD合并心功能不全组患者血浆NT-pro BNP高于未合并心功能不全组(355.71±50.87)pg/mL vs(251.45±62.92)pg/mL,差异有统计学意义(t=10.781,P<0.01);NT-Pro BNP用于区分AECOPD患者是否合并心功能不全ROC曲线下面积0.896(标准误0.027),95%CI为(0.843~0.949),NT-PRO BNP诊断AECOPD合并心功能不全的最佳临界值327.653 ng/mL,敏感度为74.29%,特异度为91.40%。结论以NT-Pro BNP判断AECOPD合并心功能不全敏感性及特异性均较好,值得临床推广。

Objective To observe the changing trend of NT-Pro BNP for chronic acute exacerbation of chronic obstructive pulmonary disease（AECOPD） patients with cardiac insufficiency, and to investigate the best cut-off value. Methods From January 2015 to December 2016, 140 AECOPD patients with cardiac insufficiency was A retrospectively analyzed, patients were divided into to the AECOPD with cardiac insufficiency patients group（Group A： n=70） or the AECOPD without cardiac insufficiency patients group（Group B： n=70）, general information（ages, genders and history of disease） were compared between groups, by using the COPD diagnosis standard and cardiac insufficiency by Chinese Medical Association of respiratory disease branch as the ＂gold standard＂, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and Youden index of NT-Pro BNP for judging AECOPD patients with cardiac insufficiency the were calculated, Area Under roc Curve（AUC） was also calculated and ROC curve was plotted to determine the best cut-off value. Results General information such ages, ganders, history of disease were similar in both groups the differences was statistically significant（P〉0.05）. NT-pro BNP in Group A were obviously higher than Group B（355.71±50.87）pg/mL vs（251.45±62.92） pg/m L,the difference was statistically significeant（t=10.781,P〈0.01）, the AUC of the curve is 0.896（SE=0.027）, 95%CI（0.843 to 0.949）, the cut off value of NT-PRO BNP for diagnosing AECOPD patients with cardiac insufficiency 327.653 ng/mL, The sensitivity and specificity were 74.29% and 91.40%. Conclusions the NT-Pro BNP is of high accuracy to predict AECOPD patients with cardiac insufficiency and should be use for further application.