氨基端前脑钠肽和老年人左心室功能不全

目的评价氨基端前脑钠肽（NT-proBNP）在诊断老年人左心室功能不全（LVD）的价值.方法用电化学发光免疫学方法（Elecsys,罗氏诊断）检测102例LVD老人和98名健康老人（对照组）血NT-proBNP,分析各种临床因素与NT-proBNP之间的关系.结果正常对照组NT-proBNP（中位数）为53.25 pg/mL,与左心室射血分数（LVEF）、血肌酐的关系密切,和年龄、性别无关.LVD老人NT-proBNP随着心功能分级（纽约心脏学会NYHA）的增加而升高.NT-proBNP还同LVEF呈良好的负相关（r=-0.735,P＜0.001）,不同LVEF的各组LVD患者间NT-proBNP水平有显著差异（P＜0.001）.多因素线性回归分析发现,NYHA心功能分级和LVEF的存在对NT-proBNP有影响.NT-proBNP探测老年人LVD的受试者工作特性曲线下面积（AUC）为0.97,界值117.6 pg/mL的灵敏度91.1%,特异度95.9%.结论NT-proBNP水平是确定老年人LVD的良好指标,与心力衰竭的严重程度以及左心室功能密切相关.

Serum N-terminal pro-brain natriuretic peptide and elderly patients with left ventricular dysfunction

Purpose Aminoterminal portion of pro-brain natriuretic peptide(NT-proBNP) appears to be useful in the screening,diagnosis and prognosis of left ventricular dysfunction(LVD) and congestive heart failure.The purpose of this study was to determine the values of serum NT-proBNP in Shanghai elderly patients with LVD. Methods We measured serum NT-proBNP in 102 elderly patients with LVD(87 males) and 98 healthy elderly(71 males) as the control.The NT-proBNP was measured by using Elecsys 2010(Roche Diagnostics,Switzerland). Results The concentrations of NT-proBNP(median) in control subjects were 53.25 pg/mL and multi-factors linear regression analysis showed that left ventricular ejection fraction(LVEF) and creatinine might correlate to NT-proBNP excluding other factors.There were no difference of age and sex.In 102 elderly patients with LVD,NT-proBNP level elevated with New York Heart Association(NYHA) classification increased.The difference was significant(P<0.001).NT-proBNP level showed a negative correlation with LVEF((r=-0.735,) P< 0.001).Multi-factors linear regression analysis showed that NYHA classification and LVEF might correlate to NT-proBNP excluding sex,age and clinic history.The area under the receiver operator characteristic curve(AUC) were 0.97 and the cut-off level was determined as 117.6 pg/mL for NT-proBNP giving a sensitivity of 91.1% and specificity of(95.9%.) Conclusions The NT-proBNP level is a sensitive indicator of LVD also in elderly patients and may trigger further cardiac investigation.