NT-ProBNP对伴肾功能不全老年患者急性心衰的诊断作用

目的:评价氨基末端脑钠肽前体(NT-proBNP)在伴肾功能不全老年患者急性心衰诊断中的应用价值。方法:收集临床主诉为呼吸困难伴肾功能不全老年患者356例,其中确诊急性心衰患者151例,测定所有患者的血清肌酐(Scr)水平,计算肾小球滤过率(eGFR)后,分为轻度肾功能不全组(n=104,eGFR≥60ml/min/1.73m2)、中度肾功能不全组(n=159,eGFR30-59ml/min/1.73m2)和重度肾功能不全组(n=93,eGFR30ml/min/1.73m2)。检测各组NT-ProBNP,比较各组中急性心衰和非急性心衰患者NT-ProBNP差异,并分析NT-ProBNP与急性心衰的相关性,评价NT-ProBNP诊断伴肾功能不全老年患者急性心衰的临床可接受性。结果:轻度到重度肾功能不全组中急性心衰患者的Log(NT-proBNP)均高于非急性心衰患者(t值分别为9.86、9.82、6.03,P0.01)。NT-proBNP升高是伴肾功能不全老年患者急性心衰的独立预测因子(OR=18.54,P0.01)。应用NT-proBNP诊断轻度到重度肾功能不全组中急性心衰患者的工作特征曲线下面积(AUC)分别为0.915、0.874和0.787,最佳诊断截点分别为800pg/ml、950pg/ml和3000pg/ml,诊断特异性分别为84%、74%和44%;轻、中度肾功能不全急性心衰患者较不按eGFR分组患者的AUC(0.835)高,最佳诊断截点(970pg/ml)低,诊断特异性(68%)高(P0.05或P0.01)。重度肾功能不全组的诊断敏感性比不按eGFR分组的所有患者高(u=3.05,P0.01),但特异性低(u=3.04,P0.01)。结论:NT-proBNP对伴肾功能不全老年患者急性心衰有诊断作用,根据eGFR分组可以提高其对轻、中度肾功能不全患者急性心衰的诊断性能。

Application of N-terminal pro-Brain Type Natriuretic Peptide in Diagnosis of Acute Heart Failure in Elderly Patients with Renal Insufficiency

Objective： To evaluate the diagnostic value of N-terminal pro-brain type natriuretic peptide（NT-proBNP） for a- cute heart failure（HF） in elderly patients with renal insufficiency. Method： 356 elderly patients with acute dyspnea and renal insufficiency were selected, including 151 patients with acute HF. Serum concentrations were measured for all patients. Estimated glomerular filtration rate（eGFR） values were calculated using the revised modification of diet in renal disease formula（MDRD）. Patients were divided into three groups based on their eGFR： mild renal insufficiency group （n = 104, eGFR≥ 60ml/min /1. 73m^2 ）, moderate renal insufficiency group （n = 159, eGFR30 - 59ml/min/1.73m^2） and severe renal insufficiency group（n= 93, eGFR〈30 ml/min /1.73m^2 ）. Serum NT-proBNP was measured for each group. Levels of NT-proBNP were compared between patients with acute HF and patients without acute HF in each group. The relationship between NT-proBNP and acute HF was analyzed. The diagnostic value of NT-proBNP was evaluated for acute HF in elderly patients with renal insufficiency. Results： Log（NT-proB- NP） in patients with acute HF was significantly higher than those without in different renal insufficiency groups（t=9.86,9.82,6.03, respectively, P〈0.01）. Increased NT-proBNP was independent predictor of acute HF in elderly patients with renal insufficiency（OR= 18.54, P〈0.01）. From mild renal insufficiency group to severe renal insufficiency group, AUC of NT-proBNP for acute HF were 0. 915,0. 874 and 0. 787, optimal cut-points were 800,950 and 3000pg/ml, which yielded 84%, 74 % and 44 % diagnostic specificity for acute HF, respectively. The AUC and diagnostic specificity of NT-proBNP for acute HF in mild or moderate renal insufficiency group were higher than in all patients＇AUC（0. 835） and diagnostic specificity（68%）, and cut-points were lower than An cut-point of 970pg/ml identify acute HF for all patients. Conclusion： NT-proBNP is useful for diagnosis