床边即时脑钠肽检测对心力衰竭患者的诊断价值  

The diagnostic application of bedside measurement of plasama brain natriuretic in patients with heart failure

作　　者：邵乐文[1] 韩阳[1] 王战坤[1] 孙坚[1] 

机构地区：[1]浙江大学医学院附属第一医院内科,杭州310003

出　　处：《中华内科杂志》2005年第2期99-101,共3页Chinese Journal of Internal Medicine

基　　金：浙江省卫生科学研究基金资助项目(2003A023)

摘　　要：　目的　探讨床边即时检测脑钠肽对心力衰竭(心衰)伴呼吸困难患者的鉴别诊断价值。方法　荧光免疫法测定 103例心衰伴呼吸困难患者血浆脑钠肽,心脏超声和漂浮导管法分别测定心脏左室射血分数(LVEF)和肺毛细血管楔压(PCWP)。结果　①心衰患者血浆脑钠肽水平明显高于非心衰组患者[ (716±86比 46±7)ng/L,P<0 01];②如以 100ng/L为正常参考值,脑钠肽诊断心衰的敏感性 95 2% (60 /63),特异性 93 0% (40 /43),排除心衰的阴性预测价值 97 1% (100 /103);③心衰患者脑钠肽水平与PCWP呈正相关 (r=0 43, P<0 01 ),与LVEF呈负相关 (r=-0 56, P<0 01)。结论　床边即时检测脑钠肽诊断心衰敏感而且特异,可作为急诊呼吸困难鉴别诊断的一个观察指标。Objective To investigate differential diagnoses value of ultra-rapid bedside measurement of brain natriuretic peptide (BNP) in patients with dyspnea. Methods Plasma BNP concentration were measured with immunofluorescence assay in 103 patients with dyspnea. Left ventricular ejection fraction(LVEF) and pulmonary capillary wedge pressure(PCWP) were determined by echocardiography and Swan-Ganz catheter in these patients on the same time, respectively. Results (1)Plasma BNP levels in the patients with heart failure were higher than those in the non-heart failure patients [(716±86 vs 46±7) ng/L,P<0.01].(2)The sensitivity, specificity and negative predictive values of Plasma BNP levels ≥ 100 pg/ml for predicting heart failure were 95.2%(60/63),93.0%(40/43) and 97.1%(100/103), respectively.(3)Plasma BNP levels were positively related to PCWP, and negatively related to LVEF(r=-0.56, both P<0.01). Conclusion Bedside BNP assay is sensitive and specific for diagnosing heart failure, and is useful in evaluating dysynea in emergency care.

关 键 词：诊断价值 心力衰竭患者 检测 床边 心脏左室射血分数 肺毛细血管楔压 血浆脑钠肽 呼吸困难 心衰患者 免疫法测定 漂浮导管法 正常参考值 心脏超声 预测价值 PCWP LVEF 观察指标 鉴别诊断 敏感性 特异性 正相关 负相关 水平 

分 类 号：R541.6[医药卫生—心血管疾病]