中段心房利钠肽原对呼吸困难人群心力衰竭的诊断价值  

Diagnostic value of MR-proANP for heart failure in dyspnea patients

作　　者：杨爱龙[1] 周露露[1] 陈曦[1] 高宏伟[1] YANG Ai-long;ZHOU Lu-lu;CHEN Xi;GAO Hong-wei;CHEN Xi(The 263 Clinical Branch of the Army General Hospital,Beijing 101149,China)

机构地区：[1]北京军区总医院263临床部,北京101149

出　　处：《蚌埠医学院学报》2017年第12期1627-1629,1633,共4页Journal of Bengbu Medical College

摘　　要：目的:评价中段心房利钠肽原(MR-proANP)对呼吸困难人群心力衰竭(心衰)的诊断价值。方法:前瞻性纳入203例因呼吸困难就诊的病人,包括96例心衰病人和107例非心衰病人。以KRYPTOR平台检测病人就诊时血浆中MR-proANP水平。采用受试者工作特征曲线法分析MR-proANP对心衰的诊断价值,同时与B型利钠肽前体N端(NT-proBNP)进行比较。采用logistic回归模型将NT-proBNP和MR-proANP合并为一个参数(NT-proBNP+MR-proANP),并分析其诊断心衰的准确性。分析纽约心脏病协会(NYHA)心功能分级、NT-proBNP水平与MR-proANP的相关性。并收集120名健康体检者的血浆,用于分析MR-proANP的参考范围。结果:心衰病人血浆MR-proANP水平明显高于非心衰病人(P<0.01)。NT-proBNP ROC曲线下面积与MR-proANP差异无统计学意义(P>0.05)。NT-proBNP和MR-proANP联合诊断心衰的ROC曲线下面积均高于MRproANP和NT-proBNP曲线下面积(P<0.05)。MR-proANP的最佳诊断界值为100 pmol/L,对应的诊断敏感性(95%CI)和特异性(95%CI)分别为0.91(0.83~0.96)和0.64(0.55~0.74)。随着NYHA心功能分级的升高,心衰病人血浆MR-proANP水平增加(P<0.01)。MR-proANP和NT-proBNP呈正相关关系(rs=0.64,P<0.01)。结论:MR-proANP对呼吸困难人群心衰的诊断具有一定帮助。联合MR-proANP和NT-proBNP可以提高心衰的诊断准确性。Objective:To explore the diagnostic value of midregion of pro-atrial natriuretic peptide(MR-proANP)for heart failure in dyspnea patients.Methods:The serum levels of MR-proANP in 203 dyspnea patients[including 96 heart failure(HF)patients and 107 non-HF patients]on admission was determined by KRYPTOR platform.The diagnostic value of MR-proANP for HF was analyzed using receiver operating characteristic(ROC)curve,and which was compared with amino-terminal pro-B type natriuretic peptide(NT-proBNP).The MR-proANP and NT-proBNP were combined into an index using logistic regression model,which was used to analyze its diagnostic accuracy for HF.The relationships between cardiac function of New York Heart Association(NYHA),NT-proBNP and MR-proANP were analyzed.The reference range of MR-proANP was established by 120 healthy examinees.Results:The serum level of MR-proANP in HF patients was higher than that in non-HF patients(P<0.01).The difference of the area under ROC curve between NT-proBNP and MR-proANP was not statistically significant(P>0.05).The area under ROC curve of the joint diagnosis of heart failure with NT-proBNP and MR-proANP was higher than that in MR-proANP or NT-proBNP(P<0.05).The optimal threshold,sensitivity and specificity of MR-proANP were 100 pmol/L,0.91(0.83 to 0.96)ad 0.64(0.55 to 0.74),respectively.With the cardiac function classification of NYHA increasing,the level of MR-proANP increased(P<0.01),and the MR-proANP was positively correlated with NT-proBNP(r s=0.64,P<0.01).Conclusions:MR-proANP is a useful diagnostic marker for HF in dyspnea patients.The combined detection of MR-proANP and NT-proBNP can improve the diagnostic accuracy of HF.

关 键 词：心力衰竭 呼吸困难 中段心房利钠肽原断 

分 类 号：R541.6[医药卫生—心血管疾病]