氨基末端B型利钠肽前体和"急性呼吸困难"的诊断及预后

目的 探讨氨基末端B型利钠肽前体(NT-proBNP)对急性呼吸困难的诊断及预后评估的应用价值.方法 回顾性分析533例急性呼吸困难患者,根据临床资料及心脏超声心动图分为急性充血性心力衰竭组(心衰组)及非心衰组,测定并比较两组患者NT-proBNP水平,评价NT-proBNP对急性呼吸困难患者鉴别诊断的价值;同时对心衰组患者随访,观察心力衰竭患者心源性再住院及死亡等事件,评价NT-proBNP对预后判定的价值.结果 心衰组患者为272例,非心衰组患者为261例,两组患者NT-proBNP水平差异具有统计学意义(3018.6±114.7)pg/mL vs.(238.6±8.7)pg/mL,P＜0.01].其中心衰组中220例患者平均随访(158±32.8)d,心源性再住院组及心源性死亡组的NT-proBNP水平显著高于无再发事件组,分别为(2683.4±86.9),(3283.4±105.7)及(1123.5±72.1)pg/mL,差异具有统计学意义(P＜0.01).COX多元回归分析显示log NT-proBNP(r=0.987;P=0.002)和心房颤动(r=0.876;P=0.005)、室性心动过速(r=0.891;P=0.005)是心源性死亡、再住院患者独立的相关因素.结论 急诊检测NT-proBNP有利于对急性呼吸困难患者做出快速诊断和鉴别诊断,NT-proBNP对急性呼吸困难中心衰患者的预后预测价值好.LogNT-proBNP、心房颤动、室性心动过速,是心源性死亡、再住院事件的独立相关因素.

The diagnostic and predictive value of amino-terminal pro-B-type natriuretic peptide (NT-proBNP)testing in patients with acute dyspnea

Objective To study the diagnostic and predictive values of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients presenting acute dyspnea. Method A total of 533 patients with dyspnea were studied. According to the clinical characteristics and echocardiographic findings, the patients were divided into two groups, namely acute congestive heart failure group (ACHF) and non-ACHF group. NT-proBNP levels were assayed in all patients in order to evaluate the diagnostic value, and predictive value in patients of ACHF group by following up study to know the clinical destination of patients to be cardiac death or re-admission into hospital. Results There were 272 ACHF patients and 261 non-ACHF patients, and the levels of NT-proBNT were significantly different between two groups ( 2683.4±86.9) pg/mL vs. (238.6+8.7) pg/mL, P＜0.01) . A total of 220 patients were followed for 158 ±32. 8 days. The level of NT-proBNT in myocardium of patients in re-admission group was 2683 + 86. 9 pg/mL and in death group was 3283.4 + 105.7 pg/mL which both were higher than that in patients without cardiac events ( 1123. 5 + 72. 1 pg/mL) ( P ＜0. 01 ) . By using multivariate Cox analysis, log NT-proBNT was ( r = 0. 987, P = 0. 002), and atrial fibrillation (r = 0. 876, P = 0. 005 ) and ventriculat tachycardia ( r=0. 891, P =0. 005) were the valid predictors of cardiac events. Conclusions Routine determination of NT-proBNT in Emergency Department should be useful for quickly sorting patients with acute dyspnea. The NT-proBNT could be used as a good prognostic indicator of ACHF. In addition, log NT-proBNT and atrial fibrillation, ventricular tachycardia were the independent risk factors of cardiac events.