NT-proBNP、TnI、D-D联合肺部超声在急性呼吸困难病因快速鉴别中的应用价值

Value of NT-proBNP,TnI,D-D combined with lung ultrasound in rapid identification of the etiology of acute dyspnea

目的探讨N-末端脑钠肽前体(NT-proBNP)、肌钙蛋白(TnI)、D-二聚体(D-D)联合肺部超声在急性呼吸困难病因快速鉴别中的应用价值。方法回顾性分析2018年2月—2021年5月南京医科大学附属无锡市人民医院收治的120例因急性呼吸困难入院患者的临床资料,依照患者病因不同分为对照组(非心源性呼吸困难,n=41)与研究组(心源性呼吸困难,n=79)。入院后患者均行肺部超声检查与血清NT-proBNP、TnI、D-D水平检测,比较两组的临床资料,比较两组肺部超声B线评分、血清NT-proBNP、TnI、D-D水平,分析肺部超声B线评分与血清NT-proBNP、TnI、D-D水平的相关性,绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)分析血清NT-proBNP、TnI、D-D水平、肺部超声B线评分及四者联合对急性呼吸困难病因为心源性呼吸困难的鉴别诊断价值。结果对照组中肺栓塞13例、慢性支气管炎急性发作10例、支气管哮喘8例、急性肺部感染5例、原发性肺癌3例,癔症1例;研究组中冠心病38例、高血压性心脏病21例、心脏瓣膜病12例、心肌病6例、其他类型心脏疾患2例。两组年龄、血氧饱和度、尿素氮、心率、收缩压、血肌酐比较无显著性差异(P>0.05)。研究组血清NT-proBNP、TnI水平,肺部超声B线评分高于对照组(P<0.05),血清D-D水平低于对照组(P<0.05)。肺部超声B线评分与血清NT-proBNP、TnI水平呈正相关(P<0.05),与血清D-D水平呈负相关(P<0.05)。ROC曲线结果显示,肺部超声B线评分、血清NT-proBNP、TnI、D-D水平及四者联合鉴别急性呼吸困难病因为心源性呼吸困难的AUC值(95%CI)分别为0.727(0.639~0.805)、0.704(0.614~0.784)、0.728(0.639~0.805)、0.738(0.650~0.814)、0.830(0.750~0.892)(P>0.05)。结论血清NT-proBNP、TnI、D-D水平和肺部超声B线评分在鉴别诊断急性呼吸困难病因为心源性呼吸困难中具有重要价值,且四者联合的鉴别诊断价值更高。

Objective To investigate the effect of N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin(TnI),D-dimer(D-D)combined with lung ultrasound in rapid identification of the etiology of acute dyspnea.Methods The clinical data of 120 patients with acute dyspnea admitted to the Wuxi People's Hospital,Nanjing Medical University from February 2018 to May 2021 were retrospectively analyzed.Patients were divided into control group(non-cardiac dyspnea,n=41)and study group(cardiac dyspnea,n=79)according to different etiologies.After admission,all patients underwent lung ultrasonography and serum NT-proBNP,TnI,D-D levels.The clinical data of the two groups were compared.The lung ultrasound B-line score,serum NT-proBNP,TnI,D-D levels were compared between the two groups.The correlation between lung ultrasound B-line score and serum NT-proBNP,TnI,D-D levels was analyzed.The receiver operating curve(ROC)was drawn,and the area under the curve(AUC)was used to analyze serum NT-proBNP,TnI,D-D levels,lung ultrasound B-line score and the combination of the four differential diagnostic value of acute dyspnea etiology from cardiogenic dyspnea.Results In the control group,there were 13 cases of pulmonary embolism,10 cases of acute exacerbation of chronic bronchitis,8 cases of bronchial asthma,5 cases of acute pulmonary infection,3 cases of primary lung cancer,and 1 case of hysteria.There were 21 cases of sexual heart disease,12 cases of valvular heart disease,6 cases of cardiomyopathy,and 2 cases of other types of heart disease.There was no significant difference in age,blood oxygen saturation,blood urea nitrogen,heart rate,systolic blood pressure and serum creatinine between the two groups(P>0.05).The serum NT-proBNP,TnI levels and lung ultrasound B-line score in the study group were higher than those in the control group(P<0.05).The serum D-D level in the study group was lower than that in the control group(P<0.05).The results of Pearson analysis showed that the lung ultrasound Bline score was positively correlated with serum NT-proBNP and TnI levels(P<0.05),and the lung ultrasound B-line score was negatively correlated with serum D-D level(P<0.05).The ROC curve results showed that the AUC values(95%CI)of lung ultrasound B-line score,serum NT-proBNP,TnI,D-D levels and their combination in identifying the cause of acute dyspnea from cardiogenic dyspnea were 0.727(0.639~0.805),0.704(0.614~0.784),0.728(0.639~0.805),0.738(0.650~0.814),0.830(0.750~0.892)(P>0.05).Conclusion Serum levels of NT-proBNP,TnI,D-D,and lung ultrasound B-line score are of great value in the differential diagnosis of acute dyspnea from cardiogenic dyspnea,and the combination of the four has a higher value in differential diagnosis.