血浆脑钠肽水平的检测对急性呼吸困难原因的诊断价值

目的检测因急性呼吸困难就诊于急诊科患者的血浆脑钠肽（b-type natriuretic peptide,BNP）水平,探讨BNP对急性呼吸困难原因的诊断价值。方法急性呼吸困难患者123例,分为心源性呼吸困难组58例和非心源性呼吸困难组65例,体检健康成人60例为对照组。测定所有患者血浆BNP含量并进行组间比较。结果心源性呼吸困难组BNP值为（570.69±505.29）pg/ml,非心源性呼吸困难组BNP值为（80.08±88.18）pg/ml,差异有明显的统计学意义（P〈0.01）。单纯舒张功能不全、单纯收缩功能不全和收缩并舒张功能不全患者BNP值各亚组间差异有统计学意义（P〈0.05）。随心功能衰竭程度的逐级增加,BNP值逐级升高,差异有统计学意义（P〈0.05）。对于伴有收缩功能不全的心衰,BNP水平与左室射血分数（LVEF）呈负相关（r=-0.763,P〈0.01）。BNP对诊断心源性呼吸困难最佳阈值（115.15pg/ml）时的敏感性、特异性、阳性预测值和阴性预测值分别为93.1%、80%、80.6%和92.9%。受试者工作特征曲线（ROC曲线）下面积为0.937（P〈0.01）。结论血浆BNP水平测定对于急性呼吸困难原因的鉴别有重要的意义,是诊断心源性呼吸困难的一项很有价值的指标。

Utility of B-type natriuretic peptide in the differentiation of etiologies of acute dyspnea

Objective Plasma B-type natriuretic peptide（BNP） levels were measured in patients presenting to the emergency department with acute dyspnea.The value of BNP for differentiating the etiologies of acute dyspnea was assessed.Methods 123 patients with acute dyspnea presenting were classified into 58 patients with cardiac dyspnea and 65 patients with non-cardic dyspnea,60 healthy adults were enrolled as controls.All patients underwent BNP assay.Results The BNP levels among patients in cardiac dyspneic group were significantly higher than those in noncardiac dyspneic group with a median value of（570.69±505.29）pg/ml vs（80.08±88.18）pg/ml（P0.01）.In cardiac dyspneic group,the BNP levels differed significantly among patients with diastolic heart failure,systolic heart failure,and combined systolic and diastolic heart failure（P0.05）.The BNP levels among patients in NYHA Class Ⅱ,NYHA Ⅲ and NYHA Ⅳ differed significantly（P0.05）.In patients with systolic heart failure,the concentration of BNP had a negative correlation with LVEF（r=-0.763,P0.01）.The optimal BNP cut-off value of 115.15pg/mL for the diagnosis of cardiac dyspnea had a sensitivity of 93.1%,a specificity of 80%,a positive predictive value of 80.6% and a negative predictive value of 92.9%.The area under the receiver operating curve was 0.937（P0.01）.Conclusion Used in conjunction with other clinical information,measurement of B-type natriuretic peptide is valuable for diagnosing cardiac etiologies of dyspnea in patients presenting to the emergency department with acute dyspnea.