N末端B型脑钠肽前体在心力衰竭中的诊断和预后价值

【目的】探讨N末端B型脑钠肽前体（NT-proBNP）对心力衰竭（简称心衰）的诊断意义以及对心衰的预后价值。【方法】设心衰组65例，对照组92例，测定血浆NT—ProBNP、左室射血分数（LVEF），左室舒张末内径（LVDd）及评价NYHA心功能分级。出院复查一次，随访病人3个月内的再入院率。【结果】①心衰组NYHAⅡ、Ⅲ、Ⅳ级与对照组的血浆lnNT-proBNP水平两两比较有统计学差异（P〈0．01），心功能越差血浆lnNT—proBNP水平显著升高。②lnNT—proBNP（取自然对数ln）与LVDd呈正相关（r=0．423，P〈0．01），lnNT—proBNP与LVEF呈负相关（r=-0．407，P〈0．01）。③NT—proBNP诊断心衰的ROC曲线显示，当cut—Off值定为459pg／mL时，正确诊断指数最高（0．578），此时敏感度76．7％，特异度100％。④心衰患者出院时NT—proBNP升高组45例，正常组20例。升高组3个月内因心衰再住院者20例（44．4％），正常组2例（10％）。【结论】NT—proBNP是诊断心衰的可靠指标，与心衰的严重程度密切相关，动态观察NT—proBNP变化水平可有效地判断心衰患者的预后。

Diagnostic and Prognostic Value of Plasma NT-proBNP in Patients with Heart Failure

[Objective]To explore the diagnostic and prognostic value of plasma NT-proBNP in patients with congestive heart failure（CHF）. [Methods] A total of 92 patients with CHF and 92 healthy controls were selected into the study. The plasma concentrations of NT-proBNP, left ventricular ejection fraction（LVEF） and left ventricular diastolic diameter（LVDd） were measured. NT proBNP was reexamined when the patients were discharged from hospital. The readmission rate in 3 months was followed up. [Resultsl There were significant differences of plasma NT proBNP level among healthy controls and NYHA Ⅱ , Ⅲ, Ⅳ in CHF patients （ P 〈0.01）. Plasma NT proBNP level was increased with NYHA cardiac classification. A positive correlation was observed between lnNT-proBNP and LVDd（r=0. 423, P 〈0.01）. A negative correlation between lnNT- proBNP and LVEF（r=--0. 407, P 〈0.01）was observed. ROC analysis indicated that at a cutoff of 459pg/ ml, the sensitivity was 76.7% and the specificity was 100%. When discharged from hospital, there were 45 patients with increased NT proBNP and 20 with normal NT-proBNP level. In 3 months, 20 patients （44.4 %） with increased NT proBNP and 2 patients（10%） with normal NT-proBNP level readmitted. [Conclusion] NT proBNP is the reliable index of heart failure, closely related to NYHA cardiac classification. Observing the changes of NT-proBNP can effectively evaluate the prognosis of patients with heart failure.