N-末端脑钠肽前体和尿酸协助鉴别急性肺血栓栓塞症和充血性心力衰竭的价值

Value of N-terminal Pro-brain Natriuretic Peptide and Uric Acid in Differential Diagnosis of Acute Pulmonary Thromboembolism and Congestive Heart Failure

【目的】探究N-末端脑钠肽前体(NT-proBNP)和尿酸对于鉴别急性肺血管栓塞症(APE)以及充血性心力衰竭(CHF)的价值.【方法】检测本院收治的93例APE患者和167例CHF患者的NT-proBNP和尿酸水平,比较其在APE和CHF患者中的差异,制作ROC曲线探究其对两者的诊断的鉴别价值.【结果】APE组患者NT-proBNP、尿酸水平显著低于CHF组,且差异具有显著性(P<0.05).制作NT-proBNP和尿酸水平诊断APE的ROC曲线,NT-proBNP的AUC为0.893,尿酸的AUC为0.762,NT-proBNP联合尿酸的AUC为0.924.选取不同截断点,选取NT-proBNP=1799.0pg/mL联合尿酸=281.0μmol/L诊断APE的敏感性为21.3%,特异性为98.9%.选取NT-proBNP=5981.0pg/mL联合尿酸=569.0μmol/L诊断APE敏感性为99.3%,特异性为19.6%.【结论】NT-proBNP和尿酸可作为鉴别APE和CHF的可靠敏感指标,具有较好的临床应用价值.

【Objective】To investigate the value of N-terminal pro-brain natriuretic peptide(NT-proBNP)and uric acid in the differential diagnosis of acute pulmonary thromboembolism(APE)and congestive heart failure(CHF).【Methods】A total of 93 APE patients and 167 CHF patients admitted to our hospital were selected.Then the NTproBNP levels were measured by electrochemiluminescence immunoassay,meanwhile the uric acid levels were analyzed by an automated biochemical analyzer.Thereafter,the differences in the levels of the two indicators between APE and CHF was analyzed,and the ROC curve was explored the differential diagnosis value for APE and CHF.【Results】The levels of NT-proBNP and uric acid in patients with APE were significantly lower than those in CHF group,the difference was statistically significant(P<0.05).The AUC of NT-proBNP was 0.893,the AUC of uric acid was 0.762,and the AUC of NT-proBNP combined with uric acid was 0.924.Different truncation points were selected to evaluate the application in APE.If NT-proBNP=1799.0 pg/mL combined with uric acid=281.0μmol/L,the APE sensitivity and specificity were 21.3%and 98.9%respectively.If NT-proBNP=5981.0 pg/mL parallel uric acid=569.0μmol/L the APE sensitivity was 99.3%and the specificity was 19.6%.【Conclusion】NT-proBNP and uric acid can be used as reliable and sensitive indicators to apply differential diagnosis of APE and CHF,which have high clinical application value.