急诊室脑钠肽测定在呼吸困难鉴别诊断中的应用  

Diagnosis value of brain natriuretic peptide in patients with dyspnea in emergency department

作　　者：陈令东[1] 顾鹏[1] 

机构地区：[1]南通大学第二附属医院急诊科,226000

出　　处：《实用医学杂志》2012年第21期3568-3570,共3页The Journal of Practical Medicine

摘　　要：目的:探讨在急诊室用快速检测脑钠肽(BNP)的方法来鉴别心源性和肺源性呼吸困难的临床价值。方法:在急诊室对199例呼吸困难患者行常规实验室检查、血气分析、心电图、胸片和心脏彩超检查,参照Framingham标准等回顾诊断是否伴有心力衰竭(充血性心力衰竭),分为心源性呼吸困难组和肺源性呼吸困难组,采用双抗夹心免疫酶法(ELISA)快速测定全血标本中的BNP水平,心脏多普勒超声检查心脏左室射血分数(EF),胸部X线片测量心胸比(CTR),比较心源性和肺源性呼吸困难患者血浆BNP水平、EF、CTR的差异。结果:心源性呼吸困难组BNP(861.43±63.4)pg/mL、EF(42.3±3.6)%、CTR0.5984±0.0451,肺源性呼吸困难组BNP(196.38±23.5)pg/mL、EF(65.6±8.3)%、CTR0.4662±0.0382,两组数据比较差异有统计学意义(其中BNPP=0.001,EFP=0.016,CTRP=0.025)。结论:心源性呼吸困难组BNP与EF值、CTR有显著相关性。急诊室快速BNP检测可以作为鉴别两类呼吸困难的重要实验室指标。Objective To investigate diagnosis value of brain natriuretic peptide （BNP） in patients with dyspnea （cardiac dyspnea or puhnonary dyspnea） in emergency department. Methods 199 patients with dyspnea were divided into two groups （cardiac dyspnea group and pulmonary dyspnea group） according to Framingham standard. The concentration of BNP, left ventricular ejection fraction（EF） and cardiothoracic ratio were measured by Enzyme-linked immunosorbent assay （ELISA）, using echocardiography, （CTR） and chest X-ray respectively. All readouts were compared between the two groups. Results The cardiac dyspnea group： BNP [ （861.43± 63.4） pg/mL], EF[（42.3 ± 3.6）%], CTR （0.598 4± 0.045 1）, the pulmonary dyspnea group： BNP[（196.38 ±23.5）pg/mL], EF [ （65.6 ± 8.3）% ], CTR（0.466 2 ± 0.038 2）. BNP concentration in the cardiac dyspnea group were significantly higher than those in the pulmonary dyspnea group （P 〈 0.01 ）, EF in the cardiac dyspnea group were significantly lower than those in the pulmonary dyspnea group （P 〈 0.05）, CTR in the cardiac dyspnea group were significantly higher than those in the pulmonary dyspnea group （P 〈 0.05）. Conclusions The BNP concentration of the dyspnea patients inereased significantly when their heart failure aggravated, there is direct correlation between the BNP and the EF, CRP. The BNP arc very important in distinguishing the reason of dyspnea caused by cardiac failure or pulmonary dyspnea in emergency department.

关 键 词：脑钠肽 充血性心力衰竭 呼吸困难 

分 类 号：R541.6[医药卫生—心血管疾病]