脑利钠肽对急性呼吸困难的鉴别诊断意义  

The value of serum brain natriuretic peptide levels in differentiating congestive heart failure from lung disease in patients presenting with dyspnea

作　　者：陈协兴[1] 洪华山[1] 王一波[1] 陈良龙[1] 江琼[1] 

机构地区：[1]福建医科大学附属协和医院心内科福建省冠心病研究所,福州350001

出　　处：《中华急诊医学杂志》2004年第4期254-256,共3页Chinese Journal of Emergency Medicine

摘　　要：目的　探讨血清脑利钠肽 (brainnatriureticpeptide,BNP)水平变化在急性呼吸困难患者中鉴别诊断的意义。方法　酶联免疫吸附法检测 5 6例充血性心力衰竭 (congestiveheartfailure ,CHF)患者 (CHF组 )和 38例有急性呼吸困难表现的非CHF患者 (非CHF组 )的血清BNP 32浓度 ,并与 30例健康成人作为正常对照组。结果　 (1)CHF组、非CHF组和对照组的BNP水平分别为 (86 7 5± 334 5 )、 (113 6± 2 8 6 )、(10 9 3± 37 6 )ng/L ,CHF组BNP水平明显高于非CHF组和对照组 ,差异均有显著性 (P <0 0 1)。 (2 )血清BNP水平对CHF的诊断界值为 12 0ng/L时 ,其灵敏度、特异性和阴性预测值分别为 10 0 %、 86 7%和86 8%。 (3)CHF组BNP水平在心功能不同分级之间有显著差异 ,与NYHA分级呈正相关 (r=0 82 5 ,P <0 0 1) ;与左心室射血分数呈负相关 (F =- 0 75 6 ,P <0 0 1)。结论　血清BNP水平对于心原性呼吸困难的鉴别诊断具有重要临床意义。Objective To investigate the value of serum brain natriuretic peptide levels in differentiating congestive heart failure(CHF) from lung disease in patients presenting with dyspnea.Methods Enzyme-linked immunosorbent assay method was used to measure the levels of serum BNP-32 in 56 patients diagnosed with CHF,38 patients with pulmonary dyspnea without CHF, and 30 healthy subjects serving as control group.Results (1) The levels of serum BNP in CHF group, dyspneic patients without CHF group and control group were (867.5 ±334.5), (113.6±28.6) and (109.3 ±37.6) ng/L respectively. The levels of serum BNP were much higher in CHF patients than those in dyspneic patients without CHF and those in healtlthy subjects (P<0.01). (2) The cutoff value of BNP for diagnosing of CHF was 120 ng/L. The sensitivity,specificity and negative predictive values in diagnosis of CHF was 100 %, 86. 7 % and 86.8%,respectively.(3)Serum BNP level had a significant positive correlation with NYHA class (r = 0.825, P<0.01 )and negative correlation with left ventricular ejection fraction (r=-0.75 6, P<0.01) in CHF patients.Conclusion The level of serum BNP has an important clinical role in differentiating CHF from lung disease in patients presenting with dyspnea.

关 键 词：脑利钠肽 急性呼吸困难 鉴别诊断 酶联免疫吸附法 检测 充血性心力衰竭 

分 类 号：R56[医药卫生—呼吸系统]