N端脑钠肽前体水平对急性呼吸困难的鉴别诊断价值

Differential Diagnostic Value of N-terminal Pro-brain Natriuretic Peptide Levels in Patients with Acute dDyspnea

目的:探讨N-端脑利钠肽前体(NT-proBNP)含量对急性呼吸困难患者的鉴别诊断作用。方法:以2012年1月-2016年10月在汕尾市第二人民医院和中山大学孙逸仙纪念医院急诊科收治的行NT-proBNP检测的急性呼吸困难患者82例为研究对象,以心源性呼吸困难患者为A组,非心源性呼吸困难患者为B组。比较两组NT-proBNP和左室射血分数(LVEF)的差异。建立受试者工作特征曲线(ROC曲线),分析NT-proBNP对心源性呼吸困难诊断的特异性、敏感性及准确性。结果:A组患者血浆NT-proBNP浓度明显高于B组、A组LVEF明显低于B组,P均<0.05。不同心功能分级患者血浆NT-proBNP水平也存在明显差异,心功能越差,血浆NT-proBNP浓度越高,P<0.05。NT-proBNP诊断心源性呼吸困难的ROC曲线下面积为0.805-0.040(95%CI 0.720-0.890),截点值为1013.5 pg/ml,敏感性为90.3%,特异性为91.2%。结论:在急性呼吸困难的鉴别诊断中,NT-proBNP具有特异性和灵敏度高的特点,可有效鉴别心源性及非心源性呼吸困难。

Objective:To explore the differential diagnostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in patients with acute dyspnea. Methods:82 patients with acute dyspnea and examined NT-proBNP in the two hospitals from Jan 2012 to Oct 2016 were selected as the subjects. All patients were divided into two groups.Patients with cardiopathic dyspnea were group A,non-cardiogenic dyspnea For the B group. The differences of NT-proBNP and left ventricular ejection fraction(LVEF)were compared between the two groups. The receiver operating characteristic curve(ROC)was established to analyze the specificity,sensitivity and accuracy of NT-proBNP in the diagnosis of cardiogenic dyspnea.Results:The plasma NT-proBNP concentration in group A was significantly higher than that in group B,and the LVEF in group A was significantly lower than that in group B(P<0.05). The plasma NT-proBNP levels were also different in patients with different cardiac function grades. The worse the cardiac function,the higher the plasma NT-proBNP concentration. The difference was statistically significant(P<0.05). The area under the ROC curve of NT-proBNP for the diagnosis of cardiac dyspnea was 0.805-0.040(95% CI 0.720-0.890). The cut-off value was 1013.5 pg/ml. The sensitivity was 90.3% and the specificity was 91.2%.Conclusion:NT-proBNP in the differential diagnosis of acute dyspnea has an important role in the identification of cardiogenic and non-cardiogenic dyspnea,and specificity and sensitivity.