NT-proBNP对慢性心力衰竭患者的诊断价值研究

[目的]探讨NT-proBNP对慢性心力衰竭（CHF）患者的诊断价值。[方法]36例CHF患者,采用间接竞争ELISA方法测定血清中NT-proBNP浓度。[结果]①心功能失代偿和代偿CHF患者NT-proBNP水平分别为（304.81±102.30）fmol/mL和（198.30±75.06）fmol/mL,P=0.01;重度和轻-中度CHF患者NT-proBNP水平分别为（392.97±101.59）fmol/mL和（255.84±63.60）fmol/mL,P〈0.001;NT-proBNP和NYHA分级的相关系数为0.65,P〈0.001;NT-proBNP诊断心功能失代偿患者敏感度达0.64,特异度达0.88。②有、无收缩功能不全的CHF患者NT-proBNP水平分别为（344.12±94.87）fmol/mL和（249.66±98.04）fmol/mL,P=0.01;有、无舒张功能不全的CHF患者血清NT-proBNP浓度分别为（299.77±88.66）fmol/mL和（205.99±61.61）fmol/mL,P=0.004;NT-proBNP和LVEF相关系数为-0.39,P=0.02;NT-proBNP和EPSS相关系数为0.54,P=0.002;NT-proBNP诊断收缩性CHF患者的敏感度为0.37,特异度为0.30;诊断舒张性CHF患者的敏感度为0.71,特异度为0.83。[结论]NT-proBNP可作为评定CHF程度的指标,并且有可能成为诊断心脏舒张功能不全的良好指标。

Study of diagnostic value of NT-proBNP in patients with coronary heart failure

[Objective] To evaluate the value of NT-proBNP in the diagnosis of chronic heart failure（CHF）.[Methods] NT-proBNP concentration were measured by an ELISA method in chronic heart failure patients（n=36）,compared with NYHA class,LVEF,EPSS,and analyzed by ROC method.[Results] ① Serum NT-proBNP concentration in the compensate and decompensate heart failure patients were（198.30±75.06） fmol/mL and（304.81±102.30） fmol/mL,P〈0.05;in the moderate and severe were （255.84±63.60） fmol/mL and（392.97±101.59） fmol/mL,P〈0.05;Serum NT-proBNP concentration was correlated with NYHA classification,rs=0.65,P〈0.001;The sensitivity and specificity for NT-proBNP diagnosing decompensate heart failure patients were 0.64 and 0.88.② Serum NT-proBNP concentration in the patients with and without systolic dysfunction were（344.12±94.87） fmol/mL and （249.66±98.04） fmol/mL,P〈0.05;in the patients with and without diastolic dysfunction were fmol/mL 299.77±88.66 and （205.99±61.61） fmol/mL,P=0.004;Serum NT-proBNP concentration was correlated with LVEF（rs=-0.39,P=0.020） and EPSS（rs=0.54,P=0.002）;Area under the ROC curve（AUC） for the systolic and the diastolic heart failure were 0.74（0.020） and 0.80（0.007） respectively.[Conclusions] NT-proBNP can be very useful for evaluating the severity of chronic heart failure and may be valuable for the diagnosis of diastolic heart failure.