B型利钠肽在心力衰竭诊断与鉴别诊断中的作用及其与心脏超声检查的比较  

The Role of BNP in Diagnosis of Congestive Heart Failure and Its Advantages over UCG

作　　者：陈菲[1] 郑亚安[1] 

机构地区：[1]北京大学第三医院急诊科

出　　处：《首都医科大学学报》2007年第4期454-456,共3页Journal of Capital Medical University

摘　　要：目的探讨B型利钠肽(BNP)对以急性呼吸困难为主诉的充血性心力衰竭(CHF)患者分级诊断的作用,并与超声心动图(UCG)比较在CHF诊断中的优势。方法对86例呼吸困难患者进行血浆BNP浓度检测,并经UCG测定左心室射血分数(LVEF),以BNP>100 ng/L和LVEF<50%为CHF的诊断标准。根据美国纽约心脏病学会(NYHA)标准,将临床诊断为CHF的患者的心功能分为四级。经统计学检验后,再与临床诊断进行对比分析。结果非CHF组与CHF组之间、不同级别CHF各组之间血浆BNP浓度差异有统计学意义,P值均小于0.001。BNP的敏感性为98.5%、阳性预测值为94.4%,阴性预测值为93.3%。BNP与UCG的特异性分别为77.8%和94.4%;阳性预测值分别为94.4%和97.8%。结论BNP是CHF诊断和鉴别诊断的快速准确且量化的指标,与UCG相比,在诊断的敏感性和CHF排除诊断价值上具有绝对优势。Objective To investigate the clinical significance of the B-type natriuretic peptide(BNP) in the differential diagnosis of acute dyspnea,its role and contribution to staging of the congestive heart failure(CHF),and its advantages for the CHF diagnosis compared with the ultrasonic cardiography(UCG). Methods The plasma BNP levels in 86 patients with dyspnea were determined and the left ventricular ejection fraction(LVEF) measured by UCG,taking BNP>100 ng/L and LVEF<50% as the diagnostic criteria of CHF.The cardiac functions of patients clinically diagnosed as CHF were divided into four stages based on the New York Heart Association(NYHA) criteria.Comparison was performed between the clinical diagnoses and BNP levels.Results The BNP levels were significantly different between the non-CHF group and CHF group,and among CHF groups at different stages.In each of which the P value was less than 0.001.BNP had high sensitivity(98.5%), positive predictive value(94.4%),and negative predictive value(93.3%).The specificity of BNP(77.8%) was slightly lower than that of UCG(94.4%);the positive predictive values were almost equal,being 94.4% and 97.8% respectively.BNP,however,had absolute advantages in terms of sensitivity and negative predictive value as compared with those of UCG which were 64.7% and 41.5%,respectively.Conclusion BNP is a rapid,accurate,and quantitative index in the diagnosis of CHF and in differential diagnosis as compared with UCG,especially in terms of the sensitivity and the negative predictive value.

关 键 词：B型利钠肽 充血性心力衰竭 超声心动图 诊断 

分 类 号：R541.6+1[医药卫生—心血管疾病]