血浆N-末端脑钠肽前体质量浓度对急性呼吸困难的诊断意义

目的:探讨血浆N-末端脑钠肽前体(NT-proBNP)质量浓度变化在急性心源性呼吸困难诊断和鉴别诊断中的临床意义。方法:选取以呼吸困难为主诉来我院急诊的患者110例,分为心源性呼吸困难组64例和非心源性呼吸困难组46例,采用酶联免疫吸附法(ELISA)检测血浆NT-proBNP质量浓度。结果:心源性呼吸困难组与非心源性呼吸困难组血浆NT-proBNP质量浓度分别为(3 641.48±2 931.53)ng.L-1和(565.83±301.53)ng.L-1,两组间比较差异有统计学意义(P<0.01)。心源性呼吸困难组中不同NYHA心功能分级的患者血浆NT-proBNP质量浓度比较差异有统计学意义(P<0.01),心功能分级越差,NT-proBNP质量浓度越高;以NT-proBNP质量浓度600 ng.L-1作为临界值,血浆NT-proBNP质量浓度对心源性呼吸困难诊断的敏感性很高(93.75%),但特异性略差(69.56%)。结论:快速检测血浆NT-proBNP用来诊断心力衰竭特别是左心衰的方法可靠、稳定、敏感、快捷,可作为鉴别急性呼吸困难病因的一个重要检查方法。

Value of plasma NT-proBNP levels in diagnosing and differentiating in acute dyspnea patients

Objective:To investigate the clinical value of the plasma NT-proBNP levels in patients with acute cardiac dyspnea or noncardiac dyspnea.Methods:110 patients with acute dyspnea were divided into two groups:cardiac dyspnea group(64 cases) and noncardiac dyspnea group(32 cases).The plasma NT-proBNP level was measured by enzyme-linked immunosorbent assay(ELISA).Results:The plasma NT-proBNP level of the cases with cardiac dyspnea and non cardiacdyspnea was(3641.48±2931.53)ng·L-1 and(565.83±301.53)ng·L-1 respectively with a significant difference(P<0.01).The plasma NT-proBNP level in the cases with different classes of the NYHA heart function was also significantly different(P<0.01),and the worse heart function,the higher plasma NT-proBNP level was.If 600 ng·L-1 was taken as a critical value,the plasma NT-proBNP level was excellently sensitive for diagnosing cardiac dyspnea(93.75%),but the specificity was not very good(69.56%).Conclusion:The plasma NT-proBNP level is highly sensitive for diagnosing cardiac dyspnea and differentiating with noncardiac dyspnea,which works in a convenient rapid way in clinic.