脑钠肽和N末端脑钠肽前体在老年舒张性心力衰竭患者中的比较  

Comparative study on BNP and NT-proBNP in the elderly with diastolic heart failure

作　　者：王亮[1] 冷文修[1] 何昆仑[1] 范利[1] 

机构地区：[1]解放军总医院南楼心血管二科,北京100853

出　　处：《中华老年心脑血管病杂志》2008年第6期416-419,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：863课题(2007AA02Z437179);北京市自然科学基金(7052063)

摘　　要：目的对老年舒张性心力衰竭（DHF）患者血浆脑钠肽（BNP）和N末端脑钠肽前体浓度进行比较，探讨其在老年DHF中的诊断价值。方法对诊断为DHF的老年患者129例（DHF组）及老年健康体检者77例（对照组）行心脏超声检查，应用酶联免疫法测定其血浆BNP浓度，采用电化学发光法双抗体夹心免疫法测定血浆N末端脑钠肽前体浓度，比较两组血浆BNP和N末端脑钠肽前体浓度及其与心脏舒张功能障碍分级的关系，并作受试者R0c曲线分析。结果DHF组血浆BNP和N末端脑钠肽前体水平均较对照组显著升高（P〈0．01）；且与舒张功能障碍程度相对应（P〈0．01）；血浆N末端脑钠肽前体水平高于BNP，并显著相关（r=0，812，P〈0.01）；ROC曲线下面积（AUC）为0，711（95％CI：0．630～0，792），120ng／L作为界值的灵敏性为81．0％，特异性为63，3％；N末端脑钠肽前体AUC为0．765（95％CI：0．691～0．839），200ng／L作为界值的灵敏性为82．3％，特异性为73．3％。结论血浆BNP和N末端脑钠肽前体均对老年DHF有一定的诊断价值；N末端脑钠肽前体是一个较BNP更为敏感的诊断DHF的生化指标。Objective To investigate the diagnostic value of plasma BNP and NT-proBNP in the elderly with diastolic heart failure（DHF）. Methods 129 elderly DHF patients and 77 senile healthy volunteers were selected. Plasma BNP and NT-proBNP were measured using sandwich immunoassay and electrochemiluminescence immunoassay, respectively. LVEF, E/A, E/Vp and so on were examined with echocardiography. Results The level of plasma BNP and NT-proBNP increased significantly in elderly DHF group compared with controls （P 〈0.01）. Both BNP and NT-proBNP showed progressive increase （P〈0.01） in proportion to the degree of diastolic dysfunction. Elevated NT-proBNP significantly correlated with BNP （r = 0. 812, P 〈0. 01）. The AUC of BNP was 0. 711（95% C1：0. 630-0. 792）. When cut-off value was 120 ng/L,the sensitivity and specificity of BNP were 81.0% and 63.3% respectively. The AUC of NT-proBNP was 0. 765（95% CI.0. 691 - 0. 839）. When cut-off value was 200 ng/L for DHF in the elderly,the sensitivity and specificity of NT-proBNP were 82. 3% and 73. 3%, respectively. Conclusion Both BNP and NT-proBNP are useful tools for diagnosis of DHF in the elderly. NT-proBNP may be a biochemical index more sensitive then BNP for diagnosis of DHF in the elderly.

关 键 词：心力衰竭 充血性 利钠肽 脑 N末端脑钠肽 病例对照研究 

分 类 号：R541.6[医药卫生—心血管疾病]