氨基末端B型利钠肽原与B型利钠肽检测在急性脑梗死合并心力衰竭时的诊断价值研究  

Diagnostic value of amino-terminal pro-brain natriuretic peptide and brain natriuretic peptide detection in the heart failure with acute cerebral infarction

作　　者：王伟佳[1] 张秀明[1] 邱宗荫[2] 温冬梅[1] 

机构地区：[1]中山大学附属中山医院检验医学中心,广东中山528403 [2]重庆医科大学医学检验系,重庆400016

出　　处：《中国现代医学杂志》2011年第33期4149-4153,4157,共6页China Journal of Modern Medicine

摘　　要：目的探讨心衰标志物氨基末端B型利钠肽原(amino-terminal pro-brain natriure ticpeptide,NT-proBNP)与B型利钠肽(brainnatriuretic peptide,BNP)在单纯心衰和急性脑梗死伴心衰患者血液水平的变化趋势及相关性,为临床医生选择合适的检测项目并科学分析检测结果提供客观依据。方法采用美国临床与实验室标准化协会(Clinical and Llaboratory Standards Institute,CLSI)颁布的EP15-A2文件对电化学发光免疫检测系统罗氏CobasE601和化学发光免疫检测系统西门子ADVIA Centaur检测NT-proBNP与BNP的精密度和准确度进行验证,并采用稀释回收试验确定高值标本的最大稀释倍数,保证试验数据符合要求;然后收集203例单纯心衰和急性脑梗死伴心衰患者与60例正常体检者标本,分析NT-proBNP与BNP结果的变化趋势与相关性;与此同时,检测急性脑梗死合并心衰患者同型半胱氨酸(homocysteine,Hcy)及NT-proBNP水平,分析二者相对于正常对照组的差异情况及相关性。方法 Cobas E601与ADVIA Centaur对NT-proB-NP与BNP检测均具有良好的重复性,总不精密度分别小于2.93%与3.50%,与定值校准品的偏差分别小于3.60%与2.60%,符合临床检测要求;超出测量上限的样本可采用的最大稀释比例均为1:2;相对于单纯心衰患者,急性脑梗死伴心衰患者NT-proBNP水平会明显抬高(P=0.003),与BNP数值间相关性差,BNP仅在急性脑梗死合并Ⅲ级心衰患者体内明显升高(P<0.001);急性脑梗死伴心衰患者Hcy与NT-proBNP测定结果均明显高于正常对照组(均P<0.001),但二者无明显相关。结论 NT-proBNP与BNP均能够很好的反应单纯心衰的严重程度,但在评价急性脑梗死合并的心力衰竭时,NT-proBNP检测结果失去诊断价值,且不可通过Hcy进行校正。在急性脑梗死合并的心力衰竭的评价中,NT-proBNP不能准确反映心帅程度,且不可通过Hcy进行校正。[ Objective ] To figure out the change trend and relationship of amino terminal pro-brain natriuretie peptide （NT-pro-BNP） and brain natriuretic peptide （BNP） in the heart failure with or without acute cerebral infarc- tion, by which clinical doctor could choose the test for diagnosis suitably and analyze the data scientifically. [ Meth- otis ] The precision and accuracy of NT-pro-BNP and BNP assays on electro-chemiluminescence immunoassay sys- tem Cobas E601 and chemiluminescence immunoassay system ADVIA Centaur were evaluated according to the EP15-A2 documents of the American Clinical and Laboratory Standards Institute （CLSI）. Diluting-recovering test was employed to find the biggest diluted time for high value samples. All above mentioned conditions determined whether the analytical performance meeting the requirements of experiments. Then samples from 203 heart failure patients witih or without acute cerebral infarction and 60 normal people were collected, and the change trend and relationship of NT-pro-BNP and BNP were analyzed. Besides, the Homocysteine （Hey） of the samples from the heartfailure with cerebral infarction patients was also detected, by which the relationship of NT-pro-BNP and Hey could be observed. [Results] The precision and accuracy were good for NT-pro-BNP and BNP detection using Cobas e601 and ADVIA Centaur. The total-CV was below 2.93% and 3.50%, respectively, and the deviation from definite value was below 3.60% and 2.60%, respectively, which were consistent with clinical requests. The recovery rate could be controlled within the range 90% -110% when samples were diluted as 1：2. Compared to patients with sim- ple heart failure, NT-pro-BNP, uneorrelated with BNP, was increased significantly in heart failure patients compli- cated with cerebral infarction （P =0.003）. However, the level of BNP would not elevated until grade Ⅲ heart failure ocemTed （P 〈0.001）. Besides, compared to control group, the level of NT-pro-BNP and Hey were elevated in heart failure wit

关 键 词：氨基末端B型利钠肽原(NT-proBNP) B型利钠肽(BNP) 心力衰竭 脑梗死 急性 同型半胱氨 酸(Hcy) 

分 类 号：R541.6[医药卫生—心血管疾病]