N-末端脑钠素原与心钠素对冠心病慢性心力衰竭诊断及预后判断价值的比较研究

目的比较N末端脑钠素原(NTProBNP)和心钠素(ANP)对冠心病慢性心力衰竭(心衰)的诊断及预后判定价值。方法入选71例冠心病患者,其中伴心衰58例,无心衰13例。用酶联免疫吸附法测定血浆NTProBNP,用放射免疫法测定血浆ANP,并与30例正常人进行比较。定期随访,记录冠心病患者心脏事件的发生情况。结果心衰患者血浆NTProBNP和ANP浓度均显著高于无心衰患者及正常人组(P均<0.05)。心功能级者NTProBNP浓度显著高于心功能、级者,血浆ANP浓度显著高于心功能级者,但与级者比较差异无显著性。血浆NTProBNP和ANP对于冠心病心衰诊断的敏感性分别为94.38%和75.86%;特异性分别为96.67%和83.33%。在(11.35±1.69)个月的随访中,心衰组中死亡者与存活者血浆NTProBNP和ANP水平差异无显著性。结论NTProBNP对冠心病心衰的诊断价值高于ANP,二者均与冠心病心衰患者短期心源性死亡无关。

Comparison study on diagnostic and prognostic value of N-terminal pro-brain natriuretic peptide and atrium natriuretic peptide in chronic congestive heart failure

OBJECTIVE: To investigate the diagnostic and prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and atrium natriuretic peptide (ANP) in chronic congestive heart failure. METHODS: Seventy-one coronary heart disease patients were enrolled in the study. Among them 58 patients were accompanied by heart failure and 13 with no heart failure. Plasma NT-ProBNP was determined with enzyme linked immunoadsorbent assay method, and plasma ANP was determined with radioimmunoassay method. The results were compared with those of 30 healthy individuals. All patients were followed up accordingly. RESULTS: Compared with patients with no heart failure and healthy individuals, the patients with heart failure had a higher plasma NT-proBNP and ANP contents. Cardiac function grade IV patients had a significantly higher plasma NT-ProBNP than cardiac function grade II and III patients, and their plasma ANP level was significantly higher than that of cardiac function grade III patients, but there was no significantly difference in ANP content between cardiac function grade IV and II. The diagnostic sensitivity of NT-proBNP and ANP was 94.38% and 75.86%, respectively. The diagnostic specificity of NT-proBNP and ANP was 96.67%, 83.33%, respectively. In the heart failure group, after being followed up for (11.35+/-1.69) months, it was found that there was no significant difference in the plasma NT-proBNP and ANP between the deaths and surviving patients. CONCLUSION: The diagnostic value of NT-proBNP in chronic heart failure is higher than that of ANP. According to our follow-up result, the plasma NT-proBNP and ANP can not be relied upon to predict short-term cardiogenic death in heart failure.