床边检测 NT-proBNP 及 cTnI 对心源性呼吸困难的临床诊断价值

目的 探讨床边联合检测氨基末端 B 型钠尿肽原（NT-proBNP）和心肌肌钙蛋白 I（cTnI）水平对心源性呼吸困难的诊断价值。 方法 选取以呼吸困难为主诉入院的患者 120 例， 入院时立即行床边 NT-proBNP、cTnI 检测， NT-proBNP＞ 300 ng/L 或 cTnI＞ 0.16 μg/L 定义为心源性呼吸困难。 根据最后诊断将呼吸困难患者分为心源组（n= 68）和肺源组（n=52）， 同时选取 30 例健康体检人群作为对照组， 对 3 组的 NT-proBNP、cTnI 水平进行分析。 研究单独检测 NT-proBNP、cTnI 和 NT-proBNP+cTnI 联合检测诊断心源性呼吸困难的敏感度和特异度。 结果 肺源组及心源组的 NT-proBNP 及 cTnI 水平均高于对照组， 且心源组高于肺源组（P＜ 0.01）。 NT-proBNP、cTnI 单独检测诊断心源性呼吸困难的敏感度分别为 67.65%和 52.94%； 两者联合检测提高至 94.12%； NT-proBNP、cTnI 单独检测时的特异度分别为 70.00%和 53.33%， 联合检测提高至 86.67%。 NT-proBNP+cTnI 联合检测的敏感度高于 NT-proBNP、 cTnI 单独检测（P＜ 0.05）， 检测特异度高于 cTnI 单独检测（P＜ 0.05）， 与 NT-proBNP 单独检测差异无统计学意义。两者联合对心源性呼吸困难诊断的阳性预测值为 94.12%（64/68）， 阴性预测值为 86.67%（26/30）。 结论 床边联合检测 NT-proBNP、cTnI 在心源性呼吸困难快速诊断中具有重要的价值， 两者联合检测能够提高其诊断的敏感度。

The clinical value of bedside testing of plasma levels of NT-proBNP and cTnI in the rapid diagnosis of cardiac dyspnea

Objective To explore the diagnostic value of combined bedside detection of aminoterminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in the diagnosis of cardiac dyspnea. Methods A total of 120 patients with dyspnea admitted in our department from June 2014 to February 2016 were included in this study. At the time of admission, NT-proBNP and cTnI levels were measured by bedside test. Values of NT-proBNP＞ 300 ng/L or cTnI＞ 0.16 mg/L were defined as positive for cardiac dyspnea. According to the final diagnosis, patients were divided into two groups: cardiac dyspnea group (n=68) and pulmonary dyspnea group (n=52). At the same time, 30 healthy people were selected as control group. Values of NT-proBNP and cTnI were used for statistical analysis between the three groups. The sensitivity and specificity of NT-proBNP, cTnI and cTnI+NT-proBNP were compared between three groups. Results The levels of NTproBNP and cTnI were significantly higher in pulmonary dyspnea group and cardiac dyspnea group than those in the control group, and the levels were significantly higher in cardiac dyspnea group than those of pulmonary dyspnea group (P<0.01). The detection sensitivity of NT-proBNP and cTnI alone was 67.65% and 52.94%, combined detection of both was up to 94.12%. The specificity of NT-proBNP and cTnI detection alone was 70.00% and 53.33%, respectively, and combined detection of both was up to 86.67%. The sensitivity of NT-proBNP+cTnI was significantly higher than that of NT-proBNP and cTnI alone (P＜ 0.05), but there was no significant difference in the specificity between combined detection and individual detection of NT-proBNP. The positive predictive value of the combined detection in the diagnosis of cardiac dyspnea was 94.12% (64/68), and the negative predictive value was 86.67% (26/30). Conclusion Bedside detection with combination of cTnI and NT-proBNP has important clinical application value in the rapid diagnosis of cardiac dyspnea, which is a rapid clinical testing method