血浆脑钠肽测定在肺源性和心源性呼吸困难鉴别诊断中的应用

目的明确血浆脑钠肽(BNP)水平对鉴别肺源性与心源性呼吸困难的诊断意义,探讨其向临床应用转化的可能性。方法采用回顾性分析的方法,分析安徽医科大学第一附属医院因呼吸困难检查血浆脑钠肽的113名患者,肺源性呼吸困难和心源性呼吸困难及左心、右心功能不全时脑钠肽水平的变化。结果肺源性呼吸困难时血浆BNP水平为(59.06±41.40)pg/ml,心源性呼吸困难时血浆BNP水平为(415.10±286.24)pg/ml,两组间比较差异具有统计学意义(P<0.001),右心功能不全时血浆BNP水平为(317.08±272.40)pg/ml,左心功能不全时血浆BNP水平为(487.18±278.22)pg/ml,两组间比较差异也有统计学意义(P<0.001)。结论肺源性与心源性呼吸困难时BNP水平升高,且升高程度与导致呼吸困难的不同原因有关,结合其他临床资料,BNP水平有助于鉴别肺源性与心源性呼吸困难以及进一步鉴别左心与右心功能不全,对快速鉴别呼吸困难原因有一定价值,可以转化应用于临床作为鉴别诊断呼吸困难原因的一个指标。

The translational application of brain natriuretic peptide measurements in pulmonary and cardiac dyspnea

Objective To elucidate the significance of plasma brain natriuretic peptide(BNP) in differentiating the pulmonary and cardiac dyspnea and to explore the possibility of its clinical application.Methods BNP was measured and analyzed in 113 cases with pulmonary or cardiac dyspnea in retrospective study.The 113 patients were divided into two groups: one was pulmonary group including 37 males and 17 females,average age being 71±10 years old;the other was cardiac group including 34 left ventricular dysfunction group and 25 right ventricular dysfunction group.The left ventricular group included 26 males and 8 females,average age being 67±12 years old;the right ventricular group included 12 males and 13 females,average age being 67±12 years old.Results The level of plasma BNP in the pulmonary dyspnea group and the cardiac dyspnea group was 59.06± 41.40pg/ml and 415.10 ± 286.24pg/ml,respectively,and the difference between the two groups was statistically significant(P<0.001).The level of plasma BNP in the left ventricular dysfunction group and the right ventricular dysfunction group was 487.18±278.22 pg/ml and 317.08±272.40 pg/ml,respectively,and there was also statistically significant difference between the two groups,(P<0.001).Conclusion BNP levels increase in the pulmonary and cardiac patients and the increased extent is related to the reason inducing dyspnea.Combined with other clinical data,we have found that the plasma BNP levels are helpful to differentiate pulmonary and cardiac dyspnea.BNP may be an indicator for rapid clinical identification of pulmonary and cardiac dyspnea.