胸水N-末端脑钠肽前体在胸腔积液患者中的诊断价值

目的 探讨检测胸液中N-末端脑钠肽前体(NT-proBNP)对于胸腔积液的鉴别诊断价值.方法 选取在本院因胸腔积液而进行诊断性胸腔穿刺的患者126例,根据临床表现、胸液常规检验结果及细胞学分为充血性心力衰竭胸腔积液33例(心源性组)和非心源性组93例(恶性胸腔积液18例、结核性胸腔积液22例、肾功能衰竭性胸腔积液19例、肝硬化腹水伴胸腔积液15例、肺炎性胸腔积液19例).检测2组患者胸水及血浆中NT proBNP水平,分析血浆NT proBNP水平与胸水NT-proBNP的相关性,并采用受试者工作曲线(ROC)计算用于判别胸水性质的最佳界值.结果 心源性组胸水及血浆中的NT-proBNP水平显著高于非心源性组、恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组,且差异均具有统计学意义(P＜0.05);恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组胸水及血浆中NT proBNP水平差异均无统计学意义(P＞0 05);胸水中NT proBNP水平与血浆中NT-proBNP水平呈显著正相关(r=0.894,P＜0.01).绘制ROC曲线结果显示,当胸水中NT-proBNP水平为1 500 ng/L时,鉴别心源性和非心源性胸水具有最大诊断指数(1.757 3),此时敏感度为89.19％、特异度为86.54％.结论 心源性胸腔积液患者胸水中NT-proBNP水平显著升高,与血浆水平呈显著正相关,以1 500 ng/L为界值时,具有鉴别诊断心源性胸水的最高价值.

Value of diagnosis of pleural effusion N-terminal pro-brain natriuretic peptide in patients with pleural effusion

Objective To detect pleural effusion N-terminal pro-brain natriuretic peptide (NT-proBNP) for the differential diagnosis of pleural effusion clinical value.Methods We selected thoracentesis in our hospital 126 cases of patients with the diagnosis,based on clinical and pathological diagnosis of congestive heart failure.Patients were divided into 33 cases of pleural effusion (cardiogenic group) and non-cardiac group,93 cases (malignant pleural liquid 18 patients,pleural effusion were 22 cases of tuberculosis,renal failure in patients with pleural effusion,19 cases of liver cirrhosis 15 cases of patients with pleural effusion,pneumonia,pleural effusion in 19 patients with detection 2 groups of patients pleural effusion and plasma NT-proBNP levels.Plasma NT-proBNP levels were analyzed in correlation with pleural effusion,and receiver operating curve (ROC) was used to find the best threshold nature of the differential diagnosis of pleural effusion.Results Pleural effusion in cardiac group was significantly higher than the plasma NT-proBNP levels of non cardiac group,the malignant group,tuberculosis group,renal failure group,cirrhosis and inflammation group and the differences were statistically significant (P ＜ 0.05);malignant,tuberculosis group,renal failure group,cirrhosis and inflammation group pleural effusion,NT-proBNP plasma levels of difference was not statistically significant (P ＞ 0.05);pleural fluid and plasma NT-proBNP levels in NT proBNP levels were significantly correlated (r =0.894,P ＜0.01);ROC curve showed Dangxiong water level of NT-proBNP 1 500 ng/L,the differential diagnosis of cardiac and non-cardiac pleural effusion have the largest diagnostic index 1.757 3,sensitivity was 89.19％,specificity was 86.54％.Conclusions NT proBNP levels of cardiac pleural effusion significantly increased,which shows a significant positive correlation between plasma levels,with the differential diagnosis of cardiac pleural effusion highest value when taking critical value 1 500 ng/L.