氨基末端B型利钠肽在心功能分级中的应用

目的：研究氨基末端B型利钠肽（NT-proBNP）水平在心功能分级中的应用。方法：选取2007年11月-2008年4月,复旦大学附属中山医院心血管疾病患者204例（年龄12～90岁）,健康人群（对照组）40例（年龄25～65岁）。按照纽约心脏病协会心功能分级（NYHA）将患者分为4组,其中NYHA Ⅰ级33例,NYHA Ⅱ级45例,NYHA Ⅲ级90例,NYHA Ⅳ级36例。测定患者血清NT-proBNP水平,同时进行超声心动图检查,记录患者左心射血分数（LVEF）。分析血清NT-proBNP水平与NYHA分级和LVEF的关系。结果：区分健康人群组和NYHA Ⅰ级疾病组NT-proBNP水平的截点值为136.8ng·L^-1,敏感度和特异性分别为88.1%和90.9%;区分NYHA Ⅰ～Ⅱ级和NYHA Ⅲ～Ⅳ级疾病组NT-proBNP水平的截点值为768.8ng·L^-1,敏感度和特异性分别为93.4%和87.2%。将对照组和疾病组分别按性别和年龄进行分组统计,结果显示各年龄组别区分健康人群组和NYHA分级疾病组NT-proBNP水平的截点值有所变化,65岁以上各组NT-proBNP水平的截点值显著高于65岁以下同组水平。疾病组LVEF值和血清NT-proBNP水平存在一定的相关性（r=0.699,P〈0.01）。结论：血清NT-proBNP可用于NYHA分级。在不同年龄段使用相应的cut-off值,可提高NYHA分级的敏感度和特异性。联合使用NT-proBNP和LVEF值对于NYHA分级有一定的辅助诊断作用。

The Use of the Serum NT-proBNP Level in the Grading of Cardiac Function

Objective:To study the use of NT-proBNP in the auxiliary diagnosis of cardiac functional grading. Methods: There were 204 patient(age from 12 to 94) with the cardiovascular diseases enrolled the Zhongshan hospital from the November of 2007 to the April of 2008. There are also 40 healthy people(age from 25 to 65) as the normal control group. These patient were divided into four groups according to the NYHA classification. There were 33 patient in NYHA I,45 patient in NYHA II,90 patient in NYHA III and 23 pat...