氨基末端B型钠尿肽前体与生物电抗法测定胸腔液体含量对呼吸困难患者病因诊断的临床研究  

The clinical research of etiological diagnosis through NT-proBNP test and Thoracic fluid content monitored by Bioreactance in patients with dyspnea

作　　者：潘建光 李红艳 王新航 张宏英 黄进宝 吕骁 马晨晖 翁恒 李天林 PAN Jian-guang;LI Hong-yan;WANG Xin-hang;ZHANG Hong-ying;HUANG Jin-bao;LV Xiao;MA Chen-hui;WENG Heng;LI Tian-lin(Respiratory Intensive Care Unit,Department of Respiratory Medicine,Fuzhou Pulmonary Hospital of Fujian,Clinical Teaching Hospital of Fujian Medical University,Fuzhou 350008,China;Department of Radiology,Fuzhou Pulmonary Hospital of Fujian,Clinical Teaching Hospital of Fujian Medical University,Fuzhou 350008,China;Department of Respiratory medicine,Xiamen Chang Gung Hospital,Xiamen 361026 Fujian,China)

机构地区：[1]福建医科大学教学医院福州肺科医院呼吸科RICU,福州350008 [2]福建医科大学教学医院福州肺科医院影像科,福州350008 [3]厦门长庚医院呼吸内科,福建厦门361026

出　　处：《创伤与急诊电子杂志》2018年第2期63-68,共6页Journal of Trauma and Emergency(Electronic Version)

基　　金：福州市科技计划项目(编号:2013-S-124-10);福建省级临床重点专科建设项目[闽卫医政函(2018)145号]

摘　　要：目的探讨检测血清氨基末端B型钠尿肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)和利用生物电抗无创心排量检测仪(noninvasive cardiac output monitor, NICOM)监测胸腔液体含量(thoracic fluid content, TFC)对呼吸困难病因诊断的临床价值。方法采用前瞻性观察性研究的方法,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共59例,临床医师以2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为诊断标准将患者分为心源性呼吸困难组(38例)和非心源性呼吸困难组(21例),通过检测血清NT-ProBNP以及利用NICOM监测TFC,收集入院当天、入院第2天、入院第3天、出院当天数据,利用SPSS19.0统计学软件分析NT-proBNP和TFC对心源性呼吸困难的诊断价值。结果心源性呼吸困难组入院当天、第2天、第3天、出院当天NT-proBNP均高于非心源性呼吸困难组(P值均小于0.05)。心源性呼吸困难组入院当天和第2天TFC均高于非心源性呼吸困难组(P值均小于0.05)。入院当天检测NT-proBNP诊断心源性呼吸困难敏感度78.95%、特异性95.24%、阳性预测值96.77%,阴性预测值71.43%。针对心源性呼吸困难和非心源性呼吸困难绘制ROC曲线,TFC的AUC为0.811(95%CI 0.705～0.918,P=0.000),当TFC截断值取53.35 k/Ω时,诊断心源性呼吸困难的敏感度为68.42%、特异性为85.71%、阳性预测值89.66%、阴性预测值60.00%。NT-proBNP联合TFC诊断心源性呼吸困难的敏感度94.74%、特异性71.43%、阳性预测值85.71%、阴性预测值88.23%。结论 NT-proBNP和TFC是诊断心源性呼吸困难的可靠指标,单独使用有较高的特异性和阳性预测值;联合诊断可提高敏感度和阴性预测值。Objective To investigate the clinical value of etiological diagnosis of dyspnea through N-terminal pro-brain natriuretic peptide（NT-proBNP） test and bioreactance noninvasive cardiac output monitor（NICOM） monitoring thoracic fluid content（TFC）. Methods A prospective observational study was conducted and 59 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease were included. The patients were divided into two groups, namely cardiogenic dyspnea group（n=38） and non-cardiogenic dyspnea group（n=21）, according to “the guidelines on the diagnosis and treatment of acute heart failure（2010）” as the standard criterion. All patients underwent serum NT-proBNP concentration test and their TFC was monitored by NICOM. The data of the patients on the admission day, the second day, the third day after admission, and discharge day were collected respectively. The value of NT-proBNP and TFC in diagnosing cardiogenic dyspnea was analyzed by SPSS 19.0. Results Compared with non-cardiogenic dyspnea group, the serum NT-proBNP concentrations on the admission day, the second day, the third day after admission, and the day of discharge were significantly higher（P 〈 0.05）in the cardiogenic dyspnea group. The TFC on the admission day and the second day after admission were significantly higher（P 〈 0.05） in the cardiogenic dyspnea group, too. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of the NT-proBNP were 78.95%, 95.24%, 96.77% and 71.43%, respectively. ROC curve showed that the area under the curve（AUC） of TFC was 0.811（95%CI 0.705～ 0.918, P=0.000）.When the cut-off of TFC was 53.35 k/Ω,the sensitivity, specificity, PPV and NPV were 68.42%, 85.71%, 89.66% and 60.00%, respectively. The sensitivity, specificity, PPV and NPV of the detection method for diagnosing cardiogenic dyspnea through both NT-proBNP and TFC were 94.74%, 71.43%, 85.71% and 88.23%, respectively. Conclusion NT-proBNP and TFC a

关 键 词：呼吸困难 诊断 鉴别 心力衰竭 促尿钠排泄肽类 血流动力学 

分 类 号：R541.6[医药卫生—心血管疾病]