脑钠肽和N末端脑钠肽前体在老年舒张性心力衰竭患者中的比较

目的对老年舒张性心力衰竭(DHF)患者血浆脑钠肽(BNP)和N末端脑钠肽前体浓度进行比较,探讨其在老年DHF中的诊断价值。方法对诊断为DHF的老年患者129例(DHF组)及老年健康体检者77例(对照组)行心脏超声检查,应用酶联免疫法测定其血浆BNP浓度,采用电化学发光法双抗体夹心免疫法测定血浆N末端脑钠肽前体浓度,比较两组血浆BNP和N末端脑钠肽前体浓度及其与心脏舒张功能障碍分级的关系,并作受试者ROC曲线分析。结果DHF组血浆BNP和N末端脑钠肽前体水平均较对照组显著升高(P<0.01);且与舒张功能障碍程度相对应(P<0.01);血浆N末端脑钠肽前体水平高于BNP,并显著相关(r=0.812,P<0.01);ROC曲线下面积(AUC)为0.711(95%CI:0.630~0.792),120 ng/L作为界值的灵敏性为81.0%,特异性为63.3%;N末端脑钠肽前体AUC为0.765(95%CI:0.691~0.839),200 ng/L作为界值的灵敏性为82.3%,特异性为73.3%。结论血浆BNP和N末端脑钠肽前体均对老年DHF有一定的诊断价值;N末端脑钠肽前体是一个较BNP更为敏感的诊断DHF的生化指标。

Comparative study on BNP and NT-proBNP in the elderly with diastolic heart failure

Objective To investigate the diagnostic value of plasma BNP and NT-proBNP in the elderly with diastolic heart failure(DHF).Methods 129 elderly DHF patients and 77 senile healthy volunteers were selected.Plasma BNP and NT-proBNP were measured using sandwich immunoassay and electrochemiluminescence immunoassay,respectively.LVEF,E/A,E/Vp and so on were examined with echocardiography.Results The level of plasma BNP and NT-proBNP increased significantly in elderly DHF group compared with controls(P<0.01).Both BNP and NT-proBNP showed progressive increase(P<0.01) in proportion to the degree of diastolic dysfunction.Elevated NT-proBNP significantly correlated with BNP(r=0.812,P<0.01).The AUC of BNP was 0.711(95% CI:0.630-0.792).When cut-off value was 120 ng/L,the sensitivity and specificity of BNP were 81.0% and 63.3% respectively.The AUC of NT-proBNP was 0.765(95%CI:0.691-0.839).When cut-off value was 200 ng/L for DHF in the elderly,the sensitivity and specificity of NT-proBNP were 82.3% and 73.3%,respectively.Conclusion Both BNP and NT-proBNP are useful tools for diagnosis of DHF in the elderly.NT-proBNP may be a biochemical index more sensitive then BNP for diagnosis of DHF in the elderly.