D-二聚体和脑钠肽对急性呼吸困难病因诊断的价值

目的 探讨D-二聚体(D-D)和脑钠肽(BNP)对急性呼吸困难病因诊断的价值.方法 用免疫比浊法检测血浆D-D,用微粒子酶免疫法检测血浆BNP.结果 肺动脉栓塞性呼吸困难组(A组)、心源性呼吸困难组(B组)和肺源性呼吸困难组(C组)血浆D-D、BNP浓度明显高于正常对照组(D组),其中A组D-D浓度明显高于其他疾病组(P均<0.01),B组BNP浓度明显高于其他疾病组(P<0.01);C组D-D浓度与B组比较差异无统计学意义,BNP浓度明显低于A组(P<0.01).D-D对肺动脉栓塞性呼吸困难诊断的灵敏度95.8%,特异性45%,阴性预测值96.4%,阳性预测值41.1%;BNP对心源性呼吸困难诊断的灵敏度73.3%,特异性94.4%,阴性预测值86.4%,阳性预测值88.0%.结论 当D-D<500 ng/mL时,可排除肺动脉栓塞性呼吸困难;BNP>500 pg/mL,可作为心源性呼吸困难的独立诊断指标.

Value of D- D and BNP in etiological diagnosis of acute dyspnea

Objective To discuss the value of D - dimer (D - D) and brain natriuretic peptide (BNP) in etiological diagnosis of acute dyspnea.Methods To test D - D in plasma with immunoturbidimetry method and BNP in plasma with microdot enzyme immunoassay analysis.Results The concentrations of D - D and BNP were obviously higher in pulmonary embolism dyspnea group,cardiogenic dyspnea group and pulmonary dyspnea group than in normal control group(P < 0.01).D-D concentration was obviously higher in pulmonary embolism dyspnea group than in other groups, and the difference was all statistically significant (P <0.01).The concentration of BNP was obviously higher in cardiogenic dyspnea group than in other groups, and the difference was statistically significant (P <0.01).There were no statistical differences in D - D concentration between pulmonary dyspnea group and cardiogenic dyspnea group.The concentration of BNP was obviously lower in pulmonary dyspnea group than in pulmonary embolism dyspnea group, and the difference was statistically significant (P <0.01).In pulmonary embolism dyspnea group, the sensitivity of D - D to diagnosis was 95.8%,specificity 45%, negative predictive value 96.4% and positive predictive value 41.1%.In cardiogenic dyspnea, the sensitivity of BNP to diagnosis was 73.3%, specificity 94.4%, negative predictive value 86.4% and positive predictive value 88.0%.Conclusion The pulmonary embolism dyspnea can be excluded, when D -D <500 ng/mL(D - D).The BNP >500 pg/mL can be regarded as independent diagnostic index of cardiogenic dyspnea.