NT-proBNP及NT-proBNP/Crea用于鉴别心源性呼吸困难和肺源性呼吸困难的诊断截点研究

NT-proBNP and NT-proBNP/Crea Were Used as Diagnostic Cut-off Points to Differentiate Cardiogenic Dyspnea From Pulmonary Dyspnea

目的建立适合中国人群不同年龄段的诊断和鉴别诊断以急诊呼吸困难为主诉的心力衰竭的NT-proBNP和NT-proBNP/Crea的cut off值。方法将133例急性呼吸困难患者分为心源性呼吸困难组(n=55)和肺源性呼吸困难组(n=78),根据年龄、性别、基本生化指标NT-proBNP及Crea水平,绘制ROC曲线,并进行统计学分析。结果心源性呼吸困难组中NT-proBNP为2744(1076,7329)pg/mL,而在肺源性呼吸困难组中NT-proBNP水平为268(80,918)pg/mL,差异具有统计学意义。心源性呼吸困难组NT-proBNP/Crea为31.3(12.02,61.21),肺源性呼吸困难组NT-proBNP/Crea为4.48(1.13,12.24),两组间差异具有统计学意义。NT-proBNP/Crea诊断心源性呼吸困难的能力是0.822(95%可信区间),最佳诊断截点是15.45。结论NT-proBNP和NT-proBNP/Crea在鉴别心源性呼吸困难和肺源性呼吸困难上有不同的诊断截点,且中国人群不同年龄段亦有不同的诊断截点。可以帮助急诊医生快速、准确诊断和鉴别诊断心源性呼吸困难及肺源性呼吸困难。

Objective:To establish the cut-off values of NT-proBNP and NT-proBNP/Crea for the di-agnosis and differential diagnosis of heart failure with dyspnea in emergency department Chinese population.Methods 133 patients with acute dyspnea were divided into two groups:Cardiogenic dyspnea group(n=55)and non-cardiogenic dyspnea group(n=78),ROC curves were drawn according to age,sex and the levels of NT-proBNP and Crea.Results The levels of NT-proBNP were 2744(1076,7329)pg/mL in the cardiogenic dysp-nea group and 268(80,918)pg/mL in the respiratory dyspnea group.The ratio of NT-proBNP/Crea was 31.3(12.02,61.21)in cardiogenic dyspnea group and 4.48(1.13,12.24)in pulmonary dyspnea group.The ability of the NT-proBNP/Crea ratio to diagnose cardiogenic dyspnea was 0.822(95%confidence interval),with an op-timal diagnostic cutoff of 15.45.Conclusion NT-proBNP and NT-proBNP/Crea have different diagnostic cut-off points in distinguishing between cardiogenic dyspnea and pulmonary dyspnea,and there are also differ-ent diagnostic cut-off points in different age groups of Chinese population,it can help emergency doctors diag-nose and diagnostic cutoff differentiate cardiogenic dyspnea and pulmonary dyspnea quickly and accurately.