心功能不全患者胸腔积液中NT-proBNP检测的意义

目的 探讨胸腔积液中N端脑钠肽前体（NT-proBNP）浓度对诊断心源性胸腔积液的价值。方法分别检测40例心功能不全伴胸腔积液患者（观察组）和32例心功能正常伴胸腔积液患者（对照组）血浆及胸腔积液中NT-proBNP的浓度,比较两组患者NT-proBNP浓度的差异。以胸腔积液NT-proBNP浓度〉1500pg/ml为截点,计算胸腔积液的NT-proBNP水平诊断心源性胸腔积液的灵敏度、特异度及约登指数。结果观察组血浆NT-proBNP水平[（3829±583）pg/ml]与对照组血浆NT-proBNP水平[（274±113）pg/ml]有统计学差异（P〈0.05）;观察组胸腔积液NT-proBNP水平[（2874±952）pg/ml]与对照组血浆NT-proBNP水平[（447±152）pg/ml]有统计学差异（P〈0.05）;观察组胸腔积液中NT-proBNP浓度〉1500pg/ml的患者比例（90.0%,36/40）明显高于对照组（12.5%,4/32）,两组比较有统计学差异（P〈0.05）。胸腔积液NT-proBNP〉1500pg/ml作为截点诊断心源性胸腔积液的灵敏度、特异度及约登指数分别为90.0%、87.5%、77.5%。结论胸腔积液中高浓度NT-proBNP有助于诊断心源性胸腔积液。

Significance of detection of NT-proBNP concentration in pleural fluid in patients with congestive heart failure accompanied

Objective To investigate the value of N-terminal-pro-brain natriuretic peptide(NT-proBNP) concentration in pleural fluid in the diagnosis of cardiogenic hydrothorax.Methods The concentration of NT-proBNP in plasma and pleural fluid were detected respectively in 40 patients with congestive heart failure accompanied by hydrothorax(observation group) and 32 ones with normal heart function accompanied by hydrothorax(control group),and the difference in NT-proBNP concentration was compared between two groups.Taking NT-proBNP concentration as cutpoint when it was higher than 1500 pg/mL,its sensitivity,specificity and Youden index in the diagnosis of cardiogenic hydrothorax were calculated.Results The comparison of plasma NT-proBNP concentration between observation group[(3829±583) pg/mL]and control group[(274±113) pg/mL]showed a statistical difference(P<0.05).The comparison of pleural fluid NT-proBNP concentration between observation group[(2874±952) pg/mL]and control group[(447±152) pg/mL]showed a statistical difference(P<0.05).The proportion of patients with higher NT-proBNP concentration(>1500 pg/mL) in pleural fluid in observation group(90.0%,36/40) was significantly higher than that in control group(12.5%,4/32,P<0.05).The sensitivity,specificity and Youden index were,respectively,90.0%,87.5% and 77.5% when pleural fluid NT-proBNP concentration(>1500 pg/mL) was taken as cutpoint for diagnosing cardiogenic hydrothorax.Conclusion A higher NT-proBNP concentration in pleural fluid is helpful to the diagnosis of cardiogenic hydrothorax.