N末端B型利钠肽原对单纯主动脉瓣狭窄心力衰竭患者的诊断价值  

Diagnostic value of NT-proBNP in identifying aortic stenosis patients with heart failure

作　　者：吴超[1] 杨跃进[1] 赵雪燕[1] 张健[1] 黄洁[1] 韦丙奇[1] 孙寒松[2] 王巍[2] 闫鹏[2] 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院心内科,100037 [2]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院心外科,100037

出　　处：《中华心血管病杂志》2010年第7期579-583,共5页Chinese Journal of Cardiology

基　　金：北京市科委重大科技支撑项目（D0906004040291）

摘　　要：目的 评价N末端B型利钠肽原（NT-proBNP）对单纯主动脉瓣狭窄（AS）心力衰竭（心衰）患者的诊断价值.方法 使用酶联免疫的方法对40例AS心衰患者（AS心衰组）和76例正常对照者（正常组）行NT-pmBNP测定,评价其对AS心衰的诊断价值.结果 与正常组相比,AS心衰组NT-proBNP水平显著增高（P〈0.01）且在纽约心功能分级（NYHA分级）Ⅱ、Ⅲ和Ⅳ级者呈逐级显著升高（均为P〈0.01）;其中,临床代偿心衰差异无统计学意义（P〉0.05）,而临床失代偿心衰升高8倍（P〈0.01）;在左室舒张期末内径（LVEDD）〉50 mm组显著高于LVEDD≤50mm组（P〈0.05）,左室射血分数（LVEF）≤60%组显著高于LVEF〉60%组（P〈0.01）;在合并心房颤动组显著高于窦性心律组（P〈0.05）.NT-pmBNP阈值在1360 ng/L时,是诊断心衰（ROC曲线下面积=0.762,P〈0.01）及失代偿心衰（ROC曲线下面积=0.997,P〈0.01）的最佳阈值;心衰与失代偿心衰诊断的敏感性分别为67.50%和100.00%,特异性均为96.05%,准确性分别为86.21%和95.83%.单因素和多元逐步回归分析一致显示,Log（NT-proBNP）与NYHA分级和LVEF呈显著正、负相关（P〈0.05）,且呈独立相关.结论 NT-pwBNP对单纯As心衰患者也有重要诊断价值.建议临床采用1360 ng/L作为阈值,诊断单纯AS伴心衰者准确性高达86.21%,尤其对失代偿者准确性高达95.83%.Objective To evaluate the diagnostic value of NT-proBNP in aortic stenosis （AS） patients with heart failure. Method We measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay （Biomedica, Vienna, Austria） in 40 AS patients with heart failure and 76 normal subjects and assessed the diagnostic value of NT-proBNP for heart failure. Results NT-proBNP levels were significantly higher in AS patients with heart failure compared to controls （ P 〈 0.01）. The level of NT-proBNP increased in proportion to the increase of NYHA functional classes （all P 〈0. 01）. The level of NT-proBNP was similar between compensated heart failure group and control group （P 〉0. 05） and significantly （8 times） increased in decompensated heart failure group （P 〈0.01 vs. control group）. NT-proBNP level was also significantly higher in LVEDD 〉50 mm group than that in LVEDD^50 mm group （P 〈0. 05） and in LVEF〉60% group than that in LVEF 〉60% group（P〈0. 01）. Patients with atrial fibrillation also had higher NT-proBNP levels compared to those with sinus rhythm （P 〈0. 05）. The NT-proBNP value of 1360 ng/L was determined as the best cutoff value for the diagnosis of AS patients with heart failure （AUC = 0. 762, P 〈 0. 01） and decompensated heart failure （AUC = 0. 997, P 〈 0. 01）, the sensitivity, specificity and accuracy were 67. 50% and 100.00% ,96. 05% and 96. 05% and 86. 21% and 95. 83% , respectively. Log （NT-proBNP） was positively related with NYHA functional class and negatively related with LVEF in univariate analysis and multiple regression analyses （P 〈0. 05）. NT-proBNP was independent correlative with NYHA functional class and LVEF. Conclusions NT-proBNP has a fairly good diagnostic potential for the identification of AS patients with heart failure. The accuracy is 86. 21% for the diagnosis of AS patients with heart failure and 95. 83% for decompensated heart failure with the diagnostic cutoff value of 1360 ng/L .

关 键 词：利钠肽 脑 心力衰竭 充血性 主动脉瓣狭窄 诊断 

分 类 号：R541.6[医药卫生—心血管疾病]