N末端B型利钠肽原对单纯主动脉瓣狭窄心力衰竭患者的诊断价值

目的 评价N末端B型利钠肽原(NT-proBNP)对单纯主动脉瓣狭窄(AS)心力衰竭(心衰)患者的诊断价值.方法 使用酶联免疫的方法对40例AS心衰患者(AS心衰组)和76例正常对照者(正常组)行NT-pmBNP测定,评价其对AS心衰的诊断价值.结果 与正常组相比,AS心衰组NT-proBNP水平显著增高(P<0.01)且在纽约心功能分级(NYHA分级)Ⅱ、Ⅲ和Ⅳ级者呈逐级显著升高(均为P<0.01);其中,临床代偿心衰差异无统计学意义(P>0.05),而临床失代偿心衰升高8倍(P<0.01);在左室舒张期末内径(LVEDD)>50 mm组显著高于LVEDD≤50mm组(P<0.05),左室射血分数(LVEF)≤60%组显著高于LVEF>60%组(P<0.01);在合并心房颤动组显著高于窦性心律组(P<0.05).NT-pmBNP阈值在1360 ng/L时,是诊断心衰(ROC曲线下面积=0.762,P<0.01)及失代偿心衰(ROC曲线下面积=0.997,P<0.01)的最佳阈值;心衰与失代偿心衰诊断的敏感性分别为67.50%和100.00%,特异性均为96.05%,准确性分别为86.21%和95.83%.单因素和多元逐步回归分析一致显示,Log(NT-proBNP)与NYHA分级和LVEF呈显著正、负相关(P<0.05),且呈独立相关.结论 NT-pwBNP对单纯As心衰患者也有重要诊断价值.建议临床采用1360 ng/L作为阈值,诊断单纯AS伴心衰者准确性高达86.21%,尤其对失代偿者准确性高达95.83%.

Diagnostic value of NT-proBNP in identifying aortic stenosis patients with heart failure

Objective To evaluate the diagnostic value of NT-proBNP in aortic stenosis (AS) patients with heart failure. Method We measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay (Biomedica, Vienna, Austria) in 40 AS patients with heart failure and 76 normal subjects and assessed the diagnostic value of NT-proBNP for heart failure. Results NT-proBNP levels were significantly higher in AS patients with heart failure compared to controls ( P < 0.01). The level of NT-proBNP increased in proportion to the increase of NYHA functional classes (all P <0. 01). The level of NT-proBNP was similar between compensated heart failure group and control group (P >0. 05) and significantly (8 times) increased in decompensated heart failure group (P <0.01 vs. control group). NT-proBNP level was also significantly higher in LVEDD >50 mm group than that in LVEDD^50 mm group (P <0. 05) and in LVEF>60% group than that in LVEF >60% group(P<0. 01). Patients with atrial fibrillation also had higher NT-proBNP levels compared to those with sinus rhythm (P <0. 05). The NT-proBNP value of 1360 ng/L was determined as the best cutoff value for the diagnosis of AS patients with heart failure (AUC = 0. 762, P < 0. 01) and decompensated heart failure (AUC = 0. 997, P < 0. 01), the sensitivity, specificity and accuracy were 67. 50% and 100.00% ,96. 05% and 96. 05% and 86. 21% and 95. 83% , respectively. Log (NT-proBNP) was positively related with NYHA functional class and negatively related with LVEF in univariate analysis and multiple regression analyses (P <0. 05). NT-proBNP was independent correlative with NYHA functional class and LVEF. Conclusions NT-proBNP has a fairly good diagnostic potential for the identification of AS patients with heart failure. The accuracy is 86. 21% for the diagnosis of AS patients with heart failure and 95. 83% for decompensated heart failure with the diagnostic cutoff value of 1360 ng/L .