B型利钠肽检测在鉴别心原性和肺原性呼吸困难中的价值  

Utility of a Rapid B-Type Natriuretic Peptide Assay in Differentiating Cardiac From Pulmonary Causes of Dyspnea

作　　者：赵茹[1] 杨丽[1] 张敬霞[1] 孙根义[1] 刘玉洁[1] 董军[1] 陈刚[1] 萧健勇[1] 张颖[1] 

机构地区：[1]天津市胸科医院心内科,300051

出　　处：《中国循环杂志》2005年第5期348-350,共3页Chinese Circulation Journal

摘　　要：目的:探讨血浆B型利钠肽(BNP)水平在鉴别慢性心力衰竭(心衰)和肺原性疾病导致呼吸困难中的临床价值。方法:对230例因呼吸困难收入急诊室的患者,床旁测试BNP值,最后由两名事前不知道BNP测试结果,各自独立的心内科医师判断这些患者是否患有慢性心衰。结果:慢性心衰患者(n=136)的血浆BNP水平为(996.3±78.2)pg/ml,明显高于最后诊断为肺部疾病的患者(n= 76),其BNP值为(70.8±21.4)pg/ml(P<0.01),有左心室功能不全但呼吸困难最终确定并非心脏原因引起的患者(n= 18),BNP值为(162.5±41.7)pg/ml。用100 pg/ml作为BNP界值时,其诊断的准确性为91%,多变量分析表明,在预测慢性心衰的各变量中BNP测定比其他的变量更具独立和重要的诊断价值。结论:血浆BNP水平有助于区分呼吸困难是否为慢性心衰或肺部疾病。Objective： We sought to assess whether a rapid assay for B-type natriuretic peptide（BNP） levels can differentiate cardiac from pulmonary causes of dyspnea. Methods： BNP levels were obtained in 230 patients presenting to the emergency department with acute dyspnea. Two independent cardiologists were blinded to BNP levels and asked to review the data and evaluate which patients presented with heart failure. Results： Patients with chronic heart failure （CHF） （ n = 136） had BNP levels of （996. 3 ± 78. 2） pg/ml, significantly higher than the patients with a final diagnosis of pulmonary disease （ n = 76） whose BNP was （ 70. 8 ± 21.4） pg/ml （ P 〈 0. 01 ）. In patients with baseline left ventricular dysfunction but whose dyspnea was not due to CHF（ n = 18）, BNP level averaged （ 162. 5 ± 41. 7） pg/ml. The diagnostic accuracy of BNP at a cutoff of 100 pg per milliliter was 91%. In multiple logistic regression analysis, BNP measurement was a more independent and important predictor than other variables for CHF. Conclusion： In conjunction with other clinical information,rapid measurement of BNP is useful in establishing or excluding the diagnosis of CHF in patients with acute dyspnea.

关 键 词：心力衰竭 B型利钠肽 诊断 

分 类 号：R541.6[医药卫生—心血管疾病]