血浆BNP测定在糖尿病左心室功能不全诊断中的应用价值

目的:探讨糖尿病并发左心室功能不全(LVD)患者血浆B型钠尿肽(BNP)水平及诊断价值。方法:选择我院2005年1月至2006年7月门诊及住院并诊断为LVD的糖尿病患者92例,随机选择无心脏疾患的糖尿病患者(单纯糖尿病组)20例和正常对照组23例,采用ELISA法测定血浆BNP浓度,超声心动图测定受试者左室射血分数(LVEF)等指标,LVD诊断以超声心动图为金标准。结果:糖尿病伴LVD组BNP水平(614.0±263.5pg/ml)明显高于正常对照组(49.2±27.5pg/ml)(P<0.01),而单纯糖尿病组BNP水平(53.6±29.0pg/ml)与正常对照组无显著性差异(P>0.05);将糖尿病伴LVD患者进行分组,单纯性左室舒张功能不全组BNP水平(295.1±85.2pg/ml)明显高于单纯糖尿病组(P<0.01),但明显低于单纯性左室收缩功能不全组(630.3±121.5pg/ml)(P<0.05),单纯性左室收缩功能不全组BNP水平低于收缩性伴舒张性左室功能不全组(1055.8±387.4pg/ml)(P<0.05)。受试者工作特征(ROC)曲线分析,BNP诊断LVD界值(cutoff值)为>90pg/ml时灵敏度为86%、特异度为92%、阳性预期值为95%、阴性预期值为76%。结论:BNP可以客观准确的评价心功能,对LVD的诊断具有理想的灵敏度和特异度,可以作为临床诊断糖尿病并发LVD的实验室指标。

Level of plasma B-type natriuretic peptide in diabetic patients with left ventricular dysfunction and its diagnostic value

Objective:To investigate the level of plasma B-type natriuretic peptide(BNP) in diabetic patients with left ventricular dysfunction(LVD) and its diagnostic value.Methods:135 subjects were selected,including 92 diabetic patients with LVD,20 diabetic patients without any heart disease diagnosed by echocardiography(isolated diabetes group) and 23 healthy controls.BNP was determined by ELISA.Left ventricular ejection fraction(LVEF) was measured by the modified Simpson's equation with echocardiography.The diagnosis of echocardiography was considered to be the gold standard for left ventricular dysfunction.Diagnostic utilities were tested by receiver operating characteristics(ROC).Results:BNP level in LVD group(614.0±263.5 pg/ml) was significantly higher than that in healthy group(49.2±27.5 pg/ml)(P<0.01),BNP level in isolated diabetes group(53.6±29.0 pg/ml)had no difference with that in healthy group(P>0.05):LVD group was divided into four groups by the echocardiography:BNP level in diastolic dysfunction group(295.1±85.2 pg/ml)was significantly higher than that in isolated diabetes group(P<0.01),but was lower than that in systolic dysfunction group(630.3±121.5 pg/ml)(P<0.05),BNP level in systolic dysfunction group was lower than that in systolic and diastolic dysfunction group(1055.8±387.4 pg/ml)(P<0.05).When cutoff value was 90pg/ml for LVD,sensitivity and specificity was 86% and 92%,positive predictive value and negative predictive value was 95% and 76% respectively.Conclusion:BNP is a valuable biomarker for the evaluation of 90pg/ml of cardiac function and the diagnosis of LVD in diabetic patients for its high sensitivity and specificity.