脑钠肽对急诊呼吸困难的鉴别诊断价值

目的 评价快速测定脑钠肽(BNP)对充血性心力衰竭(CHF)所致呼吸困难的诊断价值。方法 测定152例以呼吸困难为主诉在急诊科就诊和急诊入院患者血浆BNP水平，以两位不知道BNP结果的心血管专家根据患者的临床资料作出的诊断为标准，来评价BNP水平在以呼吸困难为主诉的患者中诊断CHF的敏感性和特异性。结果 BNP≥100pg／mL诊断CHF的敏感性为96．3％，特异性为94．3％，阳性预测值为95．2％，阴性预测值为95．7％，阳性似然率和阴性似然率分别为16．9和0．038。BNP水平与心力衰竭的严重程度相关。结论 急诊快速测定BNP有助于鉴别心源性呼吸困难与非心源性呼吸困难。

Value of brain natriuretic peptide in differential diagnosis of dyspnea in emergency department

Objective To evaluate the value of rapid assay of brain natriuretic peptide (BNP) in differential diagnosis of dyspnea resulting from congestive heart failure (CHF).Methods Plasma BNP levels were measured in 152 patients with chief complaint of dyspnea in emergency department.Clinical diagnosis of each patient was made by two cardiologists who were blind to BNP levels and only reviewed the clinical data was regarded as standard diagnosis,the sensitivity and specificity of BNP levels in diagnosis of CHF in patients with dyspnea were calculated.Results At a cutpoint of 100 pg/mL,BNP had the following decision statistics:sensitivity 96 3%,specificity 94 3%,positive predictive value 95 2%,negative predictive value 95 7%,positive likelihood ratio 16 9,and negative likelihood ratio 0 038 If BNP would have been added to emergency judgement,at a cutpoint of 100 pg/mL,16 of 21 misdiagnosed patients would have been correctly diagnosed.Conclusion Rapid test of BNP in the emergency department are useful to tell cardiac etiologies from other etiologies of dyspnea.