血清N端脑利钠肽前体对老年人呼吸困难的鉴别诊断及疗效评估价值

目的 探讨血清N端脑利钠肽前体(NT-proBNP)水平对老年人呼吸困难的鉴别诊断及疗效评估价值.方法 采用电化学发光法测定72例65岁以上心源性呼吸困难、54例非心源性呼吸困难患者血清NT-proBNP水平,25例经治疗后复查;心超测量左心室射血分数(LVEF).同期20名健康体检老年人作为对照组.结果 心源性呼吸困难组LVEF显著降低,而NT-proBNP中位数显著高于其他组(均P＜0.01),非心源性呼吸困难组NT-proBNP中位数亦高于对照组;NT-proBNP与LVEF成负相关(r=-0.548,P＜0.05);诊断试验评价结果示ROC曲线下面积为0.932,以1 500 ps/ml为临界值,诊断老年人心源性呼吸困难的阳性预测值为84.0%,阴性预测值为91.1%,准确度为86.5%.治疗有效的21例患者NT-proBNP显著下降(P＜0.01).结论 血清NT-proBNP测定在心衰的诊断和预后评估及呼吸困难的鉴别诊断中具有重要价值.对于老年患者,应适当提高诊断临界值.

Abstract：

Objective To study the differential diagnostic value and prognosis estimation of serum N-terminal pro-brain natriuretic peptide(NT-proBNP) level in the elderly patients with acute dyspnea.Methods Serum level of NT-proBNP were measured with automated electrochemiluminescence immunoassay in 72 dyspneic patients with heart failure(HF) and 54 without HF who were elder than 65 years.Itwas measured again in 25 patients after therapy.Left ventricular ejection fraction(LVEF) was measured with heart ultrasonic in the same time.Twenty healthy cases were selected as the control group.Results LVEF of the group with HF was lower than those in the control group(P<0.01) ,while both median NT-proBNP in the two groups were considerably higher than those in the control group(P<0.01) ,and levels of NT-proBNP were negatively correlated with LVEF(r=-0.548,P<0.05).An optimal strategy to identify dyspneic patients with HF was used for ROC curve analysis(area=0.932) ,which yielded 84%positive predictive value.91.1%negative predictive value and 86.5%accuracy for dyspneic patients with HF at 1 500 pg/ml cut-off.NT-proBNP levels in 21 patients who had good prognosis decreased significantly.Conclusion NT-proBNP level is valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic patients with suspected or confirmed HF.It is important to establish broader standards of the NT.proBNP in elderly dyspnoeic patients.

Differential Diagnostic Value and Prognosis Estimation of Serum NT-proBNP Level in the Elderly Patients with Acute Dyspnea