血浆脑钠素水平评价左心室收缩功能不全的意义

Effect of brain natriuretic peptide on evaluating left ventricular dysfunction

目的 :探讨我国正常人群、左心收缩功能不全及和肺源性呼吸困难患者脑钠素 (BNP)的血浆浓度 ,及其与心功能分级的关系。为BNP在心力衰竭 (心衰 )诊断和呼吸困难鉴别诊断提供理论依据。方法 :使用BIOSITE公司的Triage BNP干氏快速诊断方法对 81例心衰患者、4 0例正常者和 4 0例肺源性呼吸困难患者的BNP水平进行测量 ,比较三者间浓度差别 ;使用射血分数≤ 4 5 %作为心功能不全诊断的金标准 ,绘制ROC曲线 ,得出BNP诊断的最佳阈值。结果 :①心衰组与正常对照组及肺源性呼吸困难组的BNP水平差异有统计学意义(P <0 .0 1) ,正常对照组与肺源性呼吸困难组的BNP水平差异无统计学意义 (P >0 .0 5 ) ;②心衰组不同NYHA分级的BNP水平比较差异均有统计学意义 (均P <0 .0 1) ;③ROC曲线下面积为 0 .991,选择 97.75ng/L为BNP诊断的最佳阈值 ,其诊断心衰的敏感性为 93.8% ,特异性为 96 .1%。结论 :BNP对左心收缩功能不全有很高的灵敏度和特异度 ,可用于呼吸困难的鉴别诊断。

Objective:To evaluate the serum level of BNP in patients with left ventricular dysfunction. Method: Blood samples from 81 heart failure patients, 40 pulmonic dyspnea patients 40 healthy individual, were collected. BNP concentration were measured with Triage  BNP test. EF ≤45% was used as the gold standand of diagnosing heart failure. Result: ①There was statistical significance between heart failure group and the other two groups (P< 0.01), while no statistical significance between healthy group and pulmonary disease group (P> 0.05). ② The median concentration of BNP in different NYHA classification has statistical significance (P< 0.01). ③ A receiver-operator characteristic curve showing the sensitivity and specificity of BNP against the echocardiography diagnosis revealed the area under the curve (accuracy) was 0.991. At the BNP level of 97.75 ng/L, it was 96.1% specific and 93.8% sensitive for detecting the presence or absence of LV dysfunction. Conclusion: The data shows that BNP is sensitive and specific indicator in diagnosing LV dysfunction. It can be used in differentiatial diagnosis of dyspnea.